Healthcare Provider Details

I. General information

NPI: 1568332047
Provider Name (Legal Business Name): ISABELLA RANDHAWA MUSTO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 FIFTH AVE STE 110
SAN DIEGO CA
92103-3122
US

IV. Provider business mailing address

27798 COUNTRY LANE RD
LAGUNA NIGUEL CA
92677-3774
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: