Provider Demographics
NPI:1851177786
Name:ARIZMENDEZ, ISIS MICHELLE
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:MICHELLE
Last Name:ARIZMENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N BROADWAY STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2624
Mailing Address - Country:US
Mailing Address - Phone:714-245-6881
Mailing Address - Fax:714-245-6891
Practice Address - Street 1:2100 N BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2624
Practice Address - Country:US
Practice Address - Phone:714-245-6881
Practice Address - Fax:714-245-6891
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1457160222390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty