Provider Demographics
NPI:1629387485
Name:FISCU, DAVID (CNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FISCU
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13715 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-3859
Mailing Address - Country:US
Mailing Address - Phone:281-259-8979
Mailing Address - Fax:832-934-0172
Practice Address - Street 1:13715 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-3859
Practice Address - Country:US
Practice Address - Phone:281-259-8979
Practice Address - Fax:832-934-0172
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128689310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility