Provider Demographics
NPI:1073106035
Name:ISAAC, ALEXIS JEANNETTE
Entity Type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:JEANNETTE
Last Name:ISAAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 CENTRAL AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2653
Mailing Address - Country:US
Mailing Address - Phone:619-978-4928
Mailing Address - Fax:
Practice Address - Street 1:5012 CENTRAL AVE STE F
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-2653
Practice Address - Country:US
Practice Address - Phone:619-798-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health