Provider Demographics
NPI:1295062164
Name:ISIS HEALTH CENTER, INC
Entity type:Organization
Organization Name:ISIS HEALTH CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NOHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOELATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-451-4747
Mailing Address - Street 1:419 30TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3374
Mailing Address - Country:US
Mailing Address - Phone:510-451-4747
Mailing Address - Fax:510-451-0570
Practice Address - Street 1:419 30TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3374
Practice Address - Country:US
Practice Address - Phone:510-451-4747
Practice Address - Fax:510-451-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71602261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service