Provider Demographics
NPI:1407879489
Name:MAYEN NUNEZ, JOSE ISAIAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ISAIAS
Last Name:MAYEN NUNEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:I
Other - Last Name:MAYEN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4897
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4897
Mailing Address - Country:US
Mailing Address - Phone:281-332-1075
Mailing Address - Fax:281-332-7012
Practice Address - Street 1:561 MEDICAL CENTER BLVD STE C
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4240
Practice Address - Country:US
Practice Address - Phone:281-332-1075
Practice Address - Fax:281-332-7012
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005412547OtherAETNA
15BQOtherBCBS
TX127444105Medicaid
F73993Medicare UPIN
TX127444105Medicaid