1265105407 NPI number — ZSIENNE ANTONETTE P ISIDRO OTD, OTR

Table of content: ZSIENNE ANTONETTE P ISIDRO OTD, OTR (NPI 1265105407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265105407 NPI number — ZSIENNE ANTONETTE P ISIDRO OTD, OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISIDRO
Provider First Name:
ZSIENNE ANTONETTE
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTD, OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ISIDRO
Provider Other First Name:
ANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTD, OTR
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265105407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
349 BORDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92069-5708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-437-1494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10538 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-312-6109
Provider Business Practice Location Address Fax Number:
619-312-6110
Provider Enumeration Date:
07/25/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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