Healthcare Provider Details

I. General information

NPI: 1275826604
Provider Name (Legal Business Name): NISAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 SAN JACINTO ST STE 200
HOUSTON TX
77004-2708
US

IV. Provider business mailing address

PO BOX 24809
HOUSTON TX
77229-4809
US

V. Phone/Fax

Practice location:
  • Phone: 713-652-3145
  • Fax: 713-652-3146
Mailing address:
  • Phone: 713-652-3145
  • Fax: 713-652-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CARMEN L MANZO
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 713-378-0667