Provider Demographics
NPI:1932113487
Name:SEMBRANO, JONATHAN NUBLA (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:NUBLA
Last Name:SEMBRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE SOUTH., R200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-1177
Mailing Address - Fax:612-273-7959
Practice Address - Street 1:2450 RIVERSIDE AVE SOUTH., R200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-1177
Practice Address - Fax:612-273-7959
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49612207X00000X
IN01063463A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery