Healthcare Provider Details

I. General information

NPI: 1578810412
Provider Name (Legal Business Name): ISABELLE GERARD MADZAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ISABELLE GERARD M.D.

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR STE 230
GLENDALE CA
91205-4431
US

IV. Provider business mailing address

801 S CHEVY CHASE DR STE 230
GLENDALE CA
91205-4431
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-5586
  • Fax: 818-500-5587
Mailing address:
  • Phone: 818-500-5586
  • Fax: 818-500-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA122056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: