Provider Demographics
NPI:1093778094
Name:ISENBERG, SHERWIN (MD)
Entity Type:Individual
Prefix:
First Name:SHERWIN
Middle Name:
Last Name:ISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STEIN PLZ
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7000
Mailing Address - Country:US
Mailing Address - Phone:310-825-8840
Mailing Address - Fax:310-794-7905
Practice Address - Street 1:100 STEIN PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7000
Practice Address - Country:US
Practice Address - Phone:310-825-8840
Practice Address - Fax:310-794-7905
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26025207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A260250Medicaid
CAM050376OtherGROUP
CAW14940OtherGROUP
CAA24680Medicare UPIN
CAWA26025GMedicare PIN
CA00A260250Medicaid
CAWA26025FMedicare PIN