Provider Demographics
NPI:1255056677
Name:ZAMBRANO-SAMANIEGO, JESUS RAMON (CRNA)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:RAMON
Last Name:ZAMBRANO-SAMANIEGO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JESUS
Other - Middle Name:RAMON
Other - Last Name:ZAMBRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:11378 LAKE LOY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3846
Mailing Address - Country:US
Mailing Address - Phone:915-355-3641
Mailing Address - Fax:
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-544-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138885367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered