Provider Demographics
NPI:1962897520
Name:ISALES, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ISALES
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 1:6399 SAN IGNACIO AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1215
Mailing Address - Country:US
Mailing Address - Phone:408-369-5620
Mailing Address - Fax:408-904-7730
Practice Address - Street 1:2420 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3907
Practice Address - Country:US
Practice Address - Phone:408-369-5600
Practice Address - Fax:408-369-5615
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160479207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology