Healthcare Provider Details

I. General information

NPI: 1205754215
Provider Name (Legal Business Name): ISABELLA FAY SOUZA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 AMERICAN PACIFIC DR
HENDERSON NV
89014-8800
US

IV. Provider business mailing address

1545 WIGWAM PKWY APT 2637
HENDERSON NV
89074-8290
US

V. Phone/Fax

Practice location:
  • Phone: 702-777-8687
  • Fax:
Mailing address:
  • Phone: 707-318-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: