Provider Demographics
NPI:1023897477
Name:ZAMBRANO PETIT, JUAN MANUEL
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:ZAMBRANO PETIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11230 VICTORIA HOLLOW TRCE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2726
Mailing Address - Country:US
Mailing Address - Phone:713-517-6139
Mailing Address - Fax:
Practice Address - Street 1:9211 FM 723 RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-9237
Practice Address - Country:US
Practice Address - Phone:281-232-5500
Practice Address - Fax:346-239-3583
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311816183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician