Healthcare Provider Details

I. General information

NPI: 1760023360
Provider Name (Legal Business Name): ISAAC G HEESEN APRN-RX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 09/11/2025
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S SAN VICENTE BLVD
LOS ANGELES CA
90048-3311
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3851
  • Fax: 310-423-0246
Mailing address:
  • Phone: 310-423-3851
  • Fax: 310-423-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN-2786
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: