Provider Demographics
NPI:1265153837
Name:NEDJAR, ISABELLA OLIVIA
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:OLIVIA
Last Name:NEDJAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 E KATELLA AVE APT 3011
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-8623
Mailing Address - Country:US
Mailing Address - Phone:619-396-3233
Mailing Address - Fax:
Practice Address - Street 1:915 E KATELLA AVE APT 3011
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-8623
Practice Address - Country:US
Practice Address - Phone:619-396-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No124Q00000XDental ProvidersDental Hygienist
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93688275F21181Medicaid