Healthcare Provider Details

I. General information

NPI: 1508723693
Provider Name (Legal Business Name): ISA MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18710 SW 107TH AVE UNIT 17
CUTLER BAY FL
33157-6774
US

IV. Provider business mailing address

18710 SW 107TH AVE UNIT 17
CUTLER BAY FL
33157-6774
US

V. Phone/Fax

Practice location:
  • Phone: 786-235-2711
  • Fax:
Mailing address:
  • Phone: 786-235-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PRISCILLA PRISCILLA RUIZ
Title or Position: PRESIDENT
Credential:
Phone: 786-227-2022