Provider Demographics
NPI:1518563618
Name:HESTER, JON (SA-C)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:HESTER
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 RUDY MONTOYA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6845
Mailing Address - Country:US
Mailing Address - Phone:915-540-9570
Mailing Address - Fax:
Practice Address - Street 1:1416 RUDY MONTOYA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6845
Practice Address - Country:US
Practice Address - Phone:915-540-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19-508246ZC0007X
WI19-508246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant