Provider Demographics
NPI:1114065885
Name:ISAACS, JOHN SUDLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SUDLER
Last Name:ISAACS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 WATT AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2667
Mailing Address - Country:US
Mailing Address - Phone:916-435-8210
Mailing Address - Fax:916-971-1504
Practice Address - Street 1:3550 WATT AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2667
Practice Address - Country:US
Practice Address - Phone:916-435-8210
Practice Address - Fax:916-971-1504
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9272103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist