Provider Demographics
NPI:1437760105
Name:ISAIS, ANDREW (DEEP SEA DIVE IDC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:ISAIS
Suffix:
Gender:M
Credentials:DEEP SEA DIVE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 PASEO ENCANTADA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9421
Mailing Address - Country:US
Mailing Address - Phone:805-827-0529
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR NAVAL MEDICAL CENTER SAN DIEGO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:619-532-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman