Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY11202 | CA |
Y | 103T00000X | Psychologist | PSY11202 | CA |
NPI | 1003838079 |
---|---|
Provider Name | Elliott Isenberg |
First Address | San Francisco, CA 94110-3052 |
Second Address | San Francisco, CA 94110-3052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 28/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY112020 | (05) | CA |