Provider Demographics
NPI:1578810412
Name:GERARD MADZAR, ISABELLE (MD)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:
Last Name:GERARD MADZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ISABELLE
Other - Middle Name:
Other - Last Name:GERARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:STE 230
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-500-5586
Mailing Address - Fax:818-500-5587
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:STE 230
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-500-5586
Practice Address - Fax:818-500-5587
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine