Provider Demographics
NPI:1861984783
Name:ISAZA, ISILDA
Entity type:Individual
Prefix:
First Name:ISILDA
Middle Name:
Last Name:ISAZA
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 1:6045 ATLANTIC BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1322
Mailing Address - Country:US
Mailing Address - Phone:770-954-8097
Mailing Address - Fax:770-212-3587
Practice Address - Street 1:6045 ATLANTIC BLVD STE 204
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1322
Practice Address - Country:US
Practice Address - Phone:770-954-8097
Practice Address - Fax:770-212-3587
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-1960253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care