Provider Demographics
NPI:1497319099
Name:CAOUETTE, ISIS
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:CAOUETTE
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 1:20331 IRVINE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0223
Mailing Address - Country:US
Mailing Address - Phone:949-424-9097
Mailing Address - Fax:
Practice Address - Street 1:20331 IRVINE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0223
Practice Address - Country:US
Practice Address - Phone:949-424-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist