Healthcare Provider Details

I. General information

NPI: 1043453814
Provider Name (Legal Business Name): NEDAA N ISSA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W KETTLEMAN LN STE 200
LODI CA
95242-4337
US

IV. Provider business mailing address

1901 W KETTLEMAN LN STE 200
LODI CA
95242-4337
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-8540
  • Fax: 209-368-2885
Mailing address:
  • Phone: 209-334-8540
  • Fax: 209-368-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24915
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number152298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: