Provider Demographics
NPI:1740836857
Name:ISONO, ELIZABETH B
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:ISONO
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 1:311 OAK STREET
Mailing Address - Street 2:SUITE 113
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607
Mailing Address - Country:US
Mailing Address - Phone:510-717-1300
Mailing Address - Fax:
Practice Address - Street 1:2550 9TH STREET
Practice Address - Street 2:SUITE115
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710
Practice Address - Country:US
Practice Address - Phone:510-717-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL-047478224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant