Healthcare Provider Details

I. General information

NPI: 1225430176
Provider Name (Legal Business Name): OLIVIA ISAACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 STEWART DR APT 1127
SUNNYVALE CA
94085-3945
US

IV. Provider business mailing address

959 STEWART DR APT 1127
SUNNYVALE CA
94085-3945
US

V. Phone/Fax

Practice location:
  • Phone: 812-844-0385
  • Fax:
Mailing address:
  • Phone: 812-844-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number1280164129
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: