Most Relevant Information
Provider Data
| NPI Number: | 1003341777 |
| Provider Name: | SEAN NISAM |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/01/2017 |
| Last Updated: | 02/11/2022 |
Provider Practice Location
975 SERENO DR
VALLEJO
CA
94589
Practice Location Phone/Fax
| Phone: | 7076514071 |
| Fax: |
Provider Mailing Location
335 CARRERA DR
MILL VALLEY
CA
949413999
Provider Mailing Phone/Fax
| Phone: | 4152599013 |
| Fax: |