Healthcare Provider Details

I. General information

NPI: 1316709835
Provider Name (Legal Business Name): ISABEL HAGAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHURCH ST
PHILADELPHIA PA
19106-2201
US

IV. Provider business mailing address

460 N BROAD ST APT 409
PHILADELPHIA PA
19130-4015
US

V. Phone/Fax

Practice location:
  • Phone: 267-807-0550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: