Healthcare Provider Details

I. General information

NPI: 1982845723
Provider Name (Legal Business Name): LARRY M. ISAACS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41230 11TH ST W SUITE B
PALMDALE CA
93551-1411
US

IV. Provider business mailing address

PO BOX 9126
CANOGA PARK CA
91309-0126
US

V. Phone/Fax

Practice location:
  • Phone: 661-212-0650
  • Fax:
Mailing address:
  • Phone: 818-709-8161
  • Fax: 818-709-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG86613
License Number StateCA

VIII. Authorized Official

Name: LARRY M ISAACS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-212-0650