Provider Demographics
NPI:1588793103
Name:ISIDORO, OSCAR O (MD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:O
Last Name:ISIDORO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5509
Mailing Address - Country:US
Mailing Address - Phone:209-466-2000
Mailing Address - Fax:
Practice Address - Street 1:2320 N CALIFORNIA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5509
Practice Address - Country:US
Practice Address - Phone:209-466-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52637261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC52637OtherCALIFORNIA LICENSE
AI7290757OtherDEA