# JOSE S TISSERA MD LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881888667
- **Authorized official:** MRS. GLENDA DARLENE MCMASTER (OFFICE MANAGER)
- **Authorized official phone:** (703) 573-2301

## Contact information

- **Practice address:** 8301 ARLINGTON BLVD, \#305, FAIRFAX, VA 22031-2902
- **Practice address phone:** (703) 573-2301
- **Practice address fax:** (703) 573-5104
- **Mailing address:** 8301 ARLINGTON BLVD, \#305, FAIRFAX, VA 22031-2902
- **Mailing address phone:** (703) 573-2301
- **Mailing address fax:** (703) 573-5104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 0101023093 | VA | Yes |

## Other

- **Enumeration date:** 09/05/2007
- **Last updated:** 09/05/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6201156 | — | VA |