Provider Demographics
NPI:1275857971
Name:VALENTIN ISACESCU MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VALENTIN ISACESCU MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISACESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-726-6464
Mailing Address - Street 1:2122 S EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6209
Mailing Address - Country:US
Mailing Address - Phone:760-726-6464
Mailing Address - Fax:760-726-6483
Practice Address - Street 1:2122 S EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-726-6464
Practice Address - Fax:760-726-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA681032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH08803Medicare UPIN