Provider Demographics
NPI:1942011820
Name:VICENTE CORDOVA, VISMARI (NP)
Entity type:Individual
Prefix:
First Name:VISMARI
Middle Name:
Last Name:VICENTE CORDOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12919 W BELLFORT AVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-1838
Mailing Address - Country:US
Mailing Address - Phone:832-810-7105
Mailing Address - Fax:832-810-7106
Practice Address - Street 1:12919 W BELLFORT AVE
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-1838
Practice Address - Country:US
Practice Address - Phone:832-810-7105
Practice Address - Fax:832-810-7106
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050632163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse