Provider Demographics
NPI:1750658282
Name:ISAAC, GILBERT ANTHONY (CADAC 1)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:ANTHONY
Last Name:ISAAC
Suffix:
Gender:M
Credentials:CADAC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N PARKER ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1323
Mailing Address - Country:US
Mailing Address - Phone:714-639-5546
Mailing Address - Fax:714-639-5037
Practice Address - Street 1:525 N PARKER ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1323
Practice Address - Country:US
Practice Address - Phone:714-639-5546
Practice Address - Fax:714-639-5037
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC4961011171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator