Healthcare Provider Details

I. General information

NPI: 1205185550
Provider Name (Legal Business Name): ISOS MEDICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14454 WHITTIER BLVD
WHITTIER CA
90605-2105
US

IV. Provider business mailing address

14454 WHITTIER BLVD
WHITTIER CA
90605-2105
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-2700
  • Fax: 562-324-6831
Mailing address:
  • Phone: 562-698-2700
  • Fax: 562-324-6831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC19372
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC5966
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA42011
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA48047
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC37980
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC19801
License Number StateCA

VIII. Authorized Official

Name: PEDRO PANO
Title or Position: CEO
Credential:
Phone: 562-698-2700