Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22231 | CA |
NPI | 1114089570 |
---|---|
Provider Name | Mr. Jack Carlo Isaacs |
First Address | Fremont, CA 94538 |
Second Address | Fremont, CA 94538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |