Provider Demographics
NPI:1598009193
Name:ISLAS, JOSEFINA MARGARITA (MA)
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:MARGARITA
Last Name:ISLAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 NORTH DURFEE AVENUE, WING D
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732
Mailing Address - Country:US
Mailing Address - Phone:626-279-2530
Mailing Address - Fax:626-582-8150
Practice Address - Street 1:4024 NORTH DURFEE AVENUE, WING D
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732
Practice Address - Country:US
Practice Address - Phone:626-279-2530
Practice Address - Fax:626-582-8150
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA#95-2633765OtherMEDI-CAL