=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962478347
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN A ISKIKIAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2006
-----------------------------------------------------
Last Update Date | 07/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 481 PLUMAS BLVD STE 202
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95991-5075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-751-8777
-----------------------------------------------------
Fax | 530-671-8897
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10470 OLD PLACERVILLE RD SUITE 100
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95827-2539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-771-0335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | G49027
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------