Provider Demographics
NPI:1386209526
Name:ZAMORA, JUAN PABLO (PMHNP)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:PABLO
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 TUSCAN SUN CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4385
Mailing Address - Country:US
Mailing Address - Phone:915-373-0783
Mailing Address - Fax:
Practice Address - Street 1:3607 RIVERA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2415
Practice Address - Country:US
Practice Address - Phone:915-857-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141290363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health