Provider Demographics
NPI:1891517157
Name:DANIELS, ISABELLA (PA-C)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 FRANKFORT ST APT 6302
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3786
Mailing Address - Country:US
Mailing Address - Phone:408-930-8806
Mailing Address - Fax:
Practice Address - Street 1:3750 CONVOY ST STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3741
Practice Address - Country:US
Practice Address - Phone:619-297-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant