Provider Demographics
NPI:1144334368
Name:ISIDRO-REIGHARD, MARICEL A (CRNA)
Entity type:Individual
Prefix:DR
First Name:MARICEL
Middle Name:A
Last Name:ISIDRO-REIGHARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MARICEL
Other - Middle Name:A
Other - Last Name:ISIDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:1700 MOUNT VERNON AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4018
Practice Address - Country:US
Practice Address - Phone:661-578-7273
Practice Address - Fax:661-578-7273
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3527367500000X
CA539231163W00000X
CANA3527367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN0035270Medicaid
CARN0035270Medicaid
CAZZZ05730ZMedicare PIN
CACA229880Medicare PIN