Provider Demographics
NPI:1326450800
Name:JOE, ISABELLA
Entity Type:Individual
Prefix:MS
First Name:ISABELLA
Middle Name:
Last Name:JOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42745 PEACHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4017
Mailing Address - Country:US
Mailing Address - Phone:510-673-6399
Mailing Address - Fax:510-438-0599
Practice Address - Street 1:42745 PEACHWOOD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4017
Practice Address - Country:US
Practice Address - Phone:510-673-6399
Practice Address - Fax:510-438-0599
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015601204310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility