Healthcare Provider Details

I. General information

NPI: 1396971743
Provider Name (Legal Business Name): ISABEL BRASIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 W MAIN ST
MERCED CA
95340-4718
US

IV. Provider business mailing address

1400 K ST SUITE F
MODESTO CA
95354-1018
US

V. Phone/Fax

Practice location:
  • Phone: 209-205-1058
  • Fax: 209-205-1062
Mailing address:
  • Phone: 209-523-4573
  • Fax: 209-550-5866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: