Healthcare Provider Details

I. General information

NPI: 1255823621
Provider Name (Legal Business Name): MIRIAM MAURA ZAMORA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 NESSUH AVE
EDINBURG TX
78541-4814
US

IV. Provider business mailing address

1510 GARDEN DR
MISSION TX
78572-6564
US

V. Phone/Fax

Practice location:
  • Phone: 956-630-1116
  • Fax:
Mailing address:
  • Phone: 956-570-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number213922
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: