Basic Information
| Provider Information | |||||||||
| NPI: | 1255657979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISACHE | ||||||||
| FirstName: | CARMEN LILIANA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 653 W 8TH ST # L14 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322096511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042447514 | ||||||||
| FaxNumber: | 9042445650 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322064324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042531040 | ||||||||
| FaxNumber: | 9042531931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2010 | ||||||||
| LastUpdateDate: | 03/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | ME122625 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | ME122625 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.