Provider Demographics
NPI:1255751822
Name:RADLER, IRIS AMAY (MD)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:AMAY
Last Name:RADLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRIS
Other - Middle Name:
Other - Last Name:RADLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:136 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7002
Mailing Address - Country:US
Mailing Address - Phone:805-736-1253
Mailing Address - Fax:
Practice Address - Street 1:136 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-736-1253
Practice Address - Fax:805-736-5355
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA156191207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ37313Medicaid