Provider Demographics
NPI:1467469205
Name:NISIMBLAT, ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:NISIMBLAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SARATOGA BLVD
Mailing Address - Street 2:BLDG 5
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3477
Mailing Address - Country:US
Mailing Address - Phone:361-225-2255
Mailing Address - Fax:361-854-3672
Practice Address - Street 1:6200 SARATOGA BLVD
Practice Address - Street 2:BLDG 5
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3477
Practice Address - Country:US
Practice Address - Phone:361-225-2255
Practice Address - Fax:361-854-3672
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152221102Medicaid
TX152221102Medicaid