Provider Demographics
NPI:1659427151
Name:NASSER NAKISSA
Entity Type:Organization
Organization Name:NASSER NAKISSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-434-2488
Mailing Address - Street 1:PO BOX 28554
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-0554
Mailing Address - Country:US
Mailing Address - Phone:210-434-2488
Mailing Address - Fax:210-434-3113
Practice Address - Street 1:700 S ZARZAMORA ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5255
Practice Address - Country:US
Practice Address - Phone:210-434-2488
Practice Address - Fax:210-434-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152910901Medicaid
TXAMB224Medicare PIN