Healthcare Provider Details

I. General information

NPI: 1265356000
Provider Name (Legal Business Name): ISABELLE DOUGHERTY PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10862 BLOOMFIELD ST
LOS ALAMITOS CA
90720-2598
US

IV. Provider business mailing address

10293 BLOOMFIELD ST
LOS ALAMITOS CA
90720-2200
US

V. Phone/Fax

Practice location:
  • Phone: 714-816-3300
  • Fax:
Mailing address:
  • Phone: 562-799-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number260208494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: