Provider Demographics
NPI:1013201441
Name:COGNATA, ACACIA (ACACIA COGNATA)
Entity Type:Individual
Prefix:DR
First Name:ACACIA
Middle Name:
Last Name:COGNATA
Suffix:
Gender:F
Credentials:ACACIA COGNATA
Other - Prefix:
Other - First Name:ACACIA
Other - Middle Name:
Other - Last Name:SISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACACIA COGNATA
Mailing Address - Street 1:1617 ZENA LONA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4535
Mailing Address - Country:US
Mailing Address - Phone:832-646-9298
Mailing Address - Fax:
Practice Address - Street 1:1 BAYLOR PLZ
Practice Address - Street 2:ROOM 022D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:832-646-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX557693208000000X
NMMD2014-07342080N0001X
TXT96642080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX557693OtherTEXAS MEDICAL BOARD