Provider Demographics
NPI:1972096709
Name:ISHAK, RIOSALINE A
Entity type:Individual
Prefix:DR
First Name:RIOSALINE
Middle Name:A
Last Name:ISHAK
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 1:2255 CAHUILLA ST APT 26
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4736
Mailing Address - Country:US
Mailing Address - Phone:562-419-3585
Mailing Address - Fax:
Practice Address - Street 1:2255 CAHUILLA ST APT 26
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4736
Practice Address - Country:US
Practice Address - Phone:562-419-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist