Provider Demographics
NPI:1548005523
Name:MORTOLA, ISABELLA JOY (DNP, FNP-BC, CPNP-PC)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:JOY
Last Name:MORTOLA
Suffix:
Gender:F
Credentials:DNP, FNP-BC, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 1/2 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1805
Mailing Address - Country:US
Mailing Address - Phone:805-550-7953
Mailing Address - Fax:
Practice Address - Street 1:4455 W 117TH ST STE 200
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2240
Practice Address - Country:US
Practice Address - Phone:310-219-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner