Healthcare Provider Details

I. General information

NPI: 1942631403
Provider Name (Legal Business Name): STEVE SAMBRANO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 TRANSPORT ST SE
ALBUQUERQUE NM
87106-4382
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7248
  • Fax: 505-262-3190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2013-0077
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: