Provider Demographics
NPI:1932784279
Name:CALACSAN, GIOMER J
Entity type:Individual
Prefix:
First Name:GIOMER
Middle Name:J
Last Name:CALACSAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 SUMMER CITY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-3415
Mailing Address - Country:US
Mailing Address - Phone:832-525-9114
Mailing Address - Fax:
Practice Address - Street 1:9250 PINECROFT DR STE N2.101
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3218
Practice Address - Country:US
Practice Address - Phone:713-897-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10297092086S0102X, 363LA2100X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty