Healthcare Provider Details

I. General information

NPI: 1700046810
Provider Name (Legal Business Name): NATALIE NIKEISHA KISSOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N SAN SABA SUITE 201
SAN ANTONIO TX
78207-3154
US

IV. Provider business mailing address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-3800
  • Fax: 210-704-0065
Mailing address:
  • Phone: 210-704-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberMD14002
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ3904
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: