Provider Demographics
NPI:1851693550
Name:ZAMORA, IVAN ARTURO (LSA)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:ARTURO
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 SHADOW CREEK PKWY
Mailing Address - Street 2:STE 111-209
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7283
Mailing Address - Country:US
Mailing Address - Phone:713-289-4127
Mailing Address - Fax:
Practice Address - Street 1:11601 SHADOW CREEK PKWY
Practice Address - Street 2:STE 111-209
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7283
Practice Address - Country:US
Practice Address - Phone:713-289-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X, 363AS0400X
TX08 - 104246ZC0007X
TXSA00496246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant