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General NPI Number Information
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NPI Number | 1538159124
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH NISCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 101 THE CITY DR S
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City | ORANGE
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State | CA
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Zip | 92868-3201
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Country | US
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Telephone | 714-456-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 529 E CHESAPEAKE CIR
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City | FRESNO
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State | CA
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Zip | 93730-0740
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Country | US
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Telephone | 559-303-3666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A55139
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | A55139
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License Number State | CA
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