Provider Demographics
NPI:1164625976
Name:ISAAC, MARRISA MONIQUE (MD)
Entity Type:Individual
Prefix:
First Name:MARRISA
Middle Name:MONIQUE
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:SUITE A-200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8666
Mailing Address - Country:US
Mailing Address - Phone:512-814-0444
Mailing Address - Fax:512-814-0445
Practice Address - Street 1:4005 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE A-200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8666
Practice Address - Country:US
Practice Address - Phone:512-814-0444
Practice Address - Fax:512-814-0445
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN01222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry