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General NPI Number Information
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NPI Number | 1205185550
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Entity Type | Organization
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Legal Business Name | ISOS MEDICAL MANAGEMENT
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 14454 WHITTIER BLVD
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City | WHITTIER
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State | CA
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Zip | 90605-2105
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Country | US
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Telephone | 562-698-2700
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Fax | 562-324-6831
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Provider Business Mailing Address
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Address Line | 14454 WHITTIER BLVD
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City | WHITTIER
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State | CA
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Zip | 90605-2105
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Country | US
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Telephone | 562-698-2700
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Fax | 562-324-6831
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Authorized Official
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Title or Position | CEO
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Name | PEDRO PANO
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Credential |
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Telephone | 562-698-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC19372
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | LAC5966
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A42011
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A48047
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C37980
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | DC19801
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License Number State | CA
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