Provider Demographics
NPI:1255322137
Name:ISENBERG, HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:ISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 ALTITO WAY
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4442
Mailing Address - Country:US
Mailing Address - Phone:619-303-0404
Mailing Address - Fax:619-303-0404
Practice Address - Street 1:4833 ALTITO WAY
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-4442
Practice Address - Country:US
Practice Address - Phone:619-303-0404
Practice Address - Fax:619-303-0404
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A27678Medicare UPIN
A35079Medicare ID - Type Unspecified