Healthcare Provider Details

I. General information

NPI: 1992634802
Provider Name (Legal Business Name): SAMUEL JASSO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 UNIVERSITY BLVD
LAREDO TX
78041-1920
US

IV. Provider business mailing address

5201 UNIVERSITY BLVD
LAREDO TX
78041-1920
US

V. Phone/Fax

Practice location:
  • Phone: 956-326-2001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number842157
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: