Provider Demographics
NPI:1972602720
Name:ISACESCU, VALENTIN (MD)
Entity Type:Individual
Prefix:
First Name:VALENTIN
Middle Name:
Last Name:ISACESCU
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 1:2122 S EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6209
Mailing Address - Country:US
Mailing Address - Phone:760-726-6464
Mailing Address - Fax:760-726-6483
Practice Address - Street 1:2122 S EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-726-6464
Practice Address - Fax:760-726-6483
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA681032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A68103Medicaid
CA00A68103Medicaid