Provider Demographics
NPI:1942631403
Name:SAMBRANO, STEVE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:SAMBRANO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 LANG AVE NE
Mailing Address - Street 2:STE 100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4495
Mailing Address - Country:US
Mailing Address - Phone:505-883-2574
Mailing Address - Fax:505-265-4033
Practice Address - Street 1:4901 LANG AVE NE
Practice Address - Street 2:STE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4495
Practice Address - Country:US
Practice Address - Phone:505-883-2574
Practice Address - Fax:505-265-4033
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2013-0077363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical