Provider Demographics
NPI:1821021221
Name:ISERI, ALLEN LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:LLOYD
Last Name:ISERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 S ANAHEIM HILLS RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-282-5437
Mailing Address - Fax:714-282-8724
Practice Address - Street 1:478 S ANAHEIM HILLS RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-282-5437
Practice Address - Fax:714-282-8724
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29008208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG29008Medicare UPIN