MEDICARE: MR. IVAN ARTURO ZAMORA LSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171R00000X	Interpreter
2	246ZC0007X	Surgical Assistant	08 - 104	TX
3	246ZC0007X	Surgical Assistant	SA00496	TX
4	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1851693550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IVAN ARTURO ZAMORA LSA

Provider Business Mailing Address
First Line	:	11601 SHADOW CREEK PKWY
Second Line	:	STE 111-209
City	:	PEARLAND
State	:	TX
Zip	:	77584-7283
Country	:	US
Telephone Number	:	713-289-4127
Fax Number	:

Provider Business Practice Location Address
First Line	:	11601 SHADOW CREEK PKWY
Second Line	:	STE 111-209
City	:	PEARLAND
State	:	TX
Zip	:	77584-7283
Country	:	US
Telephone Number	:	713-289-4127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	03/19/2015

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