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General NPI Number Information
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NPI Number | 1255657979
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Entity Type | Individual
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Provider Name | CARMEN LILIANA ISACHE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 515 W 6TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-4324
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Country | US
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Telephone | 904-253-1040
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Fax | 904-253-1931
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Provider Business Mailing Address
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Address Line | 653 W 8TH ST # L14
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-7514
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Fax | 904-244-5650
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME122625
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME122625
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License Number State | FL
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