Provider Demographics
NPI:1366630550
Name:ISABELLA EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:ISABELLA EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-355-0808
Mailing Address - Street 1:PO BOX 41698
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-1698
Mailing Address - Country:US
Mailing Address - Phone:800-230-5160
Mailing Address - Fax:805-564-5087
Practice Address - Street 1:6412 LAUREL AVE
Practice Address - Street 2:MOUNTAIN MESA
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9529
Practice Address - Country:US
Practice Address - Phone:760-379-2681
Practice Address - Fax:760-379-3719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTRIWEST
CA=========OtherBLUE CROSS