Provider Demographics
NPI:1639391527
Name:NISNISAN, JOSIER MARIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSIER
Middle Name:MARIANO
Last Name:NISNISAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 CREEK WAY DR
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4072
Mailing Address - Country:US
Mailing Address - Phone:281-201-2096
Mailing Address - Fax:281-759-6447
Practice Address - Street 1:1400 CREEK WAY DR STE 201A
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4073
Practice Address - Country:US
Practice Address - Phone:281-201-2096
Practice Address - Fax:281-759-6447
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155635902Medicaid
TX155635902Medicaid
TXTXB118516Medicare Oscar/Certification