Healthcare Provider Details

I. General information

NPI: 1154765998
Provider Name (Legal Business Name): REESE PRESCOTT ISAACSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 W 6TH ST
SAN PEDRO CA
90731-2521
US

IV. Provider business mailing address

593 W 6TH ST
SAN PEDRO CA
90731-2521
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-0202
  • Fax:
Mailing address:
  • Phone: 310-547-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA134430
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number56916
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: