Provider Demographics
NPI:1245330018
Name:SAMBRANO-TANDOC, PERLITA MOLINA (NNP)
Entity type:Individual
Prefix:MS
First Name:PERLITA
Middle Name:MOLINA
Last Name:SAMBRANO-TANDOC
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:MS
Other - First Name:PERLITA
Other - Middle Name:MOLINA
Other - Last Name:SAMBRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8607 QUEEN HTS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2322
Mailing Address - Country:US
Mailing Address - Phone:210-267-5476
Mailing Address - Fax:
Practice Address - Street 1:602 EAST INDIANA AVENUE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415
Practice Address - Country:US
Practice Address - Phone:806-775-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513941363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care