Individual
HALEY MORGAN ROBERSON ISSICHOPOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSM, PA-C
Contact information
Practice address
844 PORTOLA RD, PORTOLA VALLEY, CA 94028-7207
(650) 494-1000
Mailing address
620 MOUNTAIN HOME RD, WOODSIDE, CA 94062-2516
(650) 799-0330
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
54940
CA
363AM0700X
Medical Physician Assistant
Primary
54940
CA
363AS0400X
Surgical Physician Assistant
54950
CA
Other
Enumeration date
11/07/2017
Last updated
05/10/2021
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