Provider Demographics
NPI:1073312518
Name:NISSENSON, DAVID S (PARAMEDIC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:NISSENSON
Suffix:
Gender:
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5762 SILVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:FORESTHILL
Mailing Address - State:CA
Mailing Address - Zip Code:95631-9633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5762 SILVERLEAF DR
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631-9633
Practice Address - Country:US
Practice Address - Phone:707-880-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)