Provider Demographics
NPI:1255889887
Name:TAITZ, ISAAC Y (PHD)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:Y
Last Name:TAITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7737
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7737
Mailing Address - Country:US
Mailing Address - Phone:949-522-7500
Mailing Address - Fax:949-522-7600
Practice Address - Street 1:29839 SANTA MARGARITA PKWY STE 300
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3616
Practice Address - Country:US
Practice Address - Phone:949-522-7500
Practice Address - Fax:949-522-7600
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health