Provider Demographics
NPI:1386113991
Name:ISAAC, ELLONORA (RN)
Entity type:Individual
Prefix:MS
First Name:ELLONORA
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28865 PUJOL ST APT 1624
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-6730
Mailing Address - Country:US
Mailing Address - Phone:954-918-9749
Mailing Address - Fax:
Practice Address - Street 1:28865 PUJOL ST APT 1624
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-6730
Practice Address - Country:US
Practice Address - Phone:954-918-9749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95074848163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine