Provider Demographics
NPI:1790844637
Name:ISLETA-FLORENTO, AILENE ISLES (MD)
Entity Type:Individual
Prefix:
First Name:AILENE
Middle Name:ISLES
Last Name:ISLETA-FLORENTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AILENE
Other - Middle Name:ISLES
Other - Last Name:ISLETA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:137 N COTTONWOOD ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-6646
Mailing Address - Country:US
Mailing Address - Phone:916-687-1696
Mailing Address - Fax:
Practice Address - Street 1:137 N COTTONWOOD ST STE 1500
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6646
Practice Address - Country:US
Practice Address - Phone:530-666-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA773832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A773830Medicare ID - Type Unspecified