Provider Demographics
NPI:1427695683
Name:ISIP, IMMABELLE ALICE
Entity type:Individual
Prefix:
First Name:IMMABELLE
Middle Name:ALICE
Last Name:ISIP
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 1:7108 DE SOTO AVE STE 207A
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2366
Mailing Address - Country:US
Mailing Address - Phone:818-256-3402
Mailing Address - Fax:
Practice Address - Street 1:7108 DE SOTO AVE STE 207A
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2366
Practice Address - Country:US
Practice Address - Phone:818-256-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based