Provider Demographics
NPI:1003094681
Name:CORNEJO ESQUERRA, AGUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:
Last Name:CORNEJO ESQUERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8711 VILLAGE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5419
Mailing Address - Country:US
Mailing Address - Phone:210-228-9605
Mailing Address - Fax:210-228-9632
Practice Address - Street 1:311 CAMDEN ST STE 409
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2014
Practice Address - Country:US
Practice Address - Phone:210-228-9605
Practice Address - Fax:210-228-9632
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR33012086S0122X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery