Healthcare Provider Details

I. General information

NPI: 1851384952
Provider Name (Legal Business Name): DONALD R NINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 01/18/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15055 EAST FWY SUITE A-10
CHANNELVIEW TX
77530-4144
US

IV. Provider business mailing address

15055 EAST FWY SUITE A-10
CHANNELVIEW TX
77530-4144
US

V. Phone/Fax

Practice location:
  • Phone: 281-452-4747
  • Fax: 281-457-2762
Mailing address:
  • Phone: 281-452-4747
  • Fax: 281-457-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG5432
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: