Organization
JOSE S TISSERA MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLENDA DARLENE MCMASTER (OFFICE MANAGER)
(703) 573-2301
Entity
Organization
Contact information
Practice address
8301 ARLINGTON BLVD, #305, FAIRFAX, VA 22031-2902
(703) 573-2301
(703) 573-5104
Mailing address
8301 ARLINGTON BLVD, #305, FAIRFAX, VA 22031-2902
(703) 573-2301
(703) 573-5104
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0101023093
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6201156
—
VA
Enumeration date
09/05/2007
Last updated
09/05/2007
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