Provider Demographics
NPI:1215027537
Name:BAKST, ISAAC (MBBCH)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:BAKST
Suffix:
Gender:M
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 UNIVERSITY CENTER LN
Mailing Address - Street 2:207
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1006
Mailing Address - Country:US
Mailing Address - Phone:858-552-8828
Mailing Address - Fax:858-552-8858
Practice Address - Street 1:8929 UNIVERSITY CENTER LN
Practice Address - Street 2:207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1006
Practice Address - Country:US
Practice Address - Phone:858-552-8828
Practice Address - Fax:858-552-8858
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA405982084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A85472Medicare UPIN
HA40598Medicare ID - Type Unspecified