Provider Demographics
NPI:1922166982
Name:ISAAC, RODNEY
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:
Last Name:ISAAC
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RODNEY
Other - Middle Name:
Other - Last Name:ISAAC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:446 ALTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92158-3040
Mailing Address - Country:US
Mailing Address - Phone:619-671-6589
Mailing Address - Fax:
Practice Address - Street 1:446 ALTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92158-0001
Practice Address - Country:US
Practice Address - Phone:619-671-6589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X, 390200000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist