Healthcare Provider Details

I. General information

NPI: 1033154182
Provider Name (Legal Business Name): ISABEL PURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SKYPARK DR 220
TORRANCE CA
90505-5023
US

IV. Provider business mailing address

21 BUGGY WHIP DR
ROLLING HILLS CA
90274-5008
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-5750
  • Fax: 310-257-5753
Mailing address:
  • Phone: 858-382-1407
  • Fax: 310-257-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC43273
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC43273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: