Gustavo Samuel Zambrano

Primary specialty

Magnetic Resonance Imaging Radiologic TechnologistTaxonomy code 2471M1202X

License

CRT69752 Issued in FL

Practice address

4410 N Pearline St
Maize, KS 67101-9020

Phone

(305) 910-7062

NPI assigned

Sep 22, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1801567698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 N PEARLINE ST",
            "city": "MAIZE",
            "state": "KS",
            "postal_code": "671019020",
            "telephone_number": "305-910-7062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 N PEARLINE ST",
            "city": "MAIZE",
            "state": "KS",
            "postal_code": "671019020",
            "telephone_number": "305-910-7062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAMBRANO",
        "first_name": "GUSTAVO",
        "middle_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-22",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "FL",
            "license": "465406",
            "primary": false
        },
        {
            "code": "2471N0900X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Nuclear Medicine Technology",
            "state": "FL",
            "license": "032575",
            "primary": false
        },
        {
            "code": "2471M1202X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": "FL",
            "license": "CRT69752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Magnetic Resonance Imaging Radiologic Technologist in Maize, KS
• Providers in Maize, KS by specialty
• Magnetic Resonance Imaging Radiologic Technologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.