Healthcare Provider Details

I. General information

NPI: 1194755215
Provider Name (Legal Business Name): MARK ALAN ISRAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 BRANDYWINE PL
DAVIS CA
95616-2905
US

IV. Provider business mailing address

2716 BRANDYWINE PL
DAVIS CA
95616-2905
US

V. Phone/Fax

Practice location:
  • Phone: 603-381-3373
  • Fax:
Mailing address:
  • Phone: 603-381-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG70099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: