Provider Demographics
NPI:1205185550
Name:ISOS MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:ISOS MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:PANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-698-2700
Mailing Address - Street 1:14454 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2105
Mailing Address - Country:US
Mailing Address - Phone:562-698-2700
Mailing Address - Fax:562-324-6831
Practice Address - Street 1:14454 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2105
Practice Address - Country:US
Practice Address - Phone:562-698-2700
Practice Address - Fax:562-324-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19372111N00000X
CADC19801111NX0800X
CALAC5966171100000X
CAA42011174400000X
CAA48047174400000X
CAC37980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty