Provider Demographics
NPI:1962438473
Name:ISAZADE, ALEKSANDER A (MD)
Entity type:Individual
Prefix:
First Name:ALEKSANDER
Middle Name:A
Last Name:ISAZADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:153 PIMLICO DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3657
Mailing Address - Country:US
Mailing Address - Phone:925-945-1929
Mailing Address - Fax:925-945-1929
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-1025
Practice Address - Fax:707-651-2743
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA84738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A847380Medicaid
CA00A847380Medicaid