Provider Demographics
NPI:1386752087
Name:ISABA, HILARIO A (MD)
Entity type:Individual
Prefix:
First Name:HILARIO
Middle Name:A
Last Name:ISABA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HILARIO
Other - Middle Name:A
Other - Last Name:ISABA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4910 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1410
Mailing Address - Country:US
Mailing Address - Phone:786-431-1643
Mailing Address - Fax:
Practice Address - Street 1:4910 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1410
Practice Address - Country:US
Practice Address - Phone:786-431-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042941208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27969Medicare UPIN