Provider Demographics
NPI:1922673276
Name:ISAK, PAVLO (MD)
Entity Type:Individual
Prefix:MR
First Name:PAVLO
Middle Name:
Last Name:ISAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:555 N EL CAMINO REAL STE A
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6745
Mailing Address - Country:US
Mailing Address - Phone:949-357-2897
Mailing Address - Fax:949-499-9590
Practice Address - Street 1:113 WATERWORKS WAY STE 300
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3174
Practice Address - Country:US
Practice Address - Phone:949-450-0880
Practice Address - Fax:949-450-0804
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2022-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA170182208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery