Provider Demographics
NPI:1114950623
Name:ALEJANDRO ISAVA MD PA
Entity Type:Organization
Organization Name:ALEJANDRO ISAVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-321-7234
Mailing Address - Street 1:1520 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1520
Mailing Address - Country:US
Mailing Address - Phone:305-321-7234
Mailing Address - Fax:305-675-0662
Practice Address - Street 1:1520 NE 26TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1520
Practice Address - Country:US
Practice Address - Phone:305-321-7234
Practice Address - Fax:305-675-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME771812080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62806OtherBCBS
FL264364200Medicaid