Healthcare Provider Details

I. General information

NPI: 1538268073
Provider Name (Legal Business Name): ANTONIOS ISSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY ISSA M.D.

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WELCH RD STE 315
PALO ALTO CA
94304-1510
US

IV. Provider business mailing address

PO BOX 1917
SOQUEL CA
95073-1917
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-5711
  • Fax: 650-725-8351
Mailing address:
  • Phone: 831-359-3014
  • Fax: 831-462-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA52946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: