Healthcare Provider Details

I. General information

NPI: 1396785598
Provider Name (Legal Business Name): MARK NEAL ISAACS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/25/2023
Certification Date: 01/09/2023
Deactivation Date: 01/04/2023
Reactivation Date: 01/09/2023

III. Provider practice location address

1981 N BROADWAY STE 270
WALNUT CREEK CA
94596-3886
US

IV. Provider business mailing address

630 THOMAS L BERKLEY WAY APT 508
OAKLAND CA
94612-1865
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-6442
  • Fax: 925-932-6260
Mailing address:
  • Phone: 510-569-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG32292
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG32292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: