Healthcare Provider Details

I. General information

NPI: 1487042768
Provider Name (Legal Business Name): JOSEPH ISAACSON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S SAN VICENTE BLVD SUITE 603
LOS ANGELES CA
90048-4165
US

IV. Provider business mailing address

444 S SAN VICENTE BLVD SUITE 603
LOS ANGELES CA
90048-4165
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-2513
  • Fax: 310-652-2568
Mailing address:
  • Phone: 310-423-2513
  • Fax: 310-652-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG31190
License Number StateCA

VIII. Authorized Official

Name: JOSEPH ISAACSON
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 310-423-2515