Provider Demographics
NPI:1053320713
Name:ESQUIVEL, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:ESQUIVEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:956-447-2668
Mailing Address - Fax:956-229-6196
Practice Address - Street 1:1210 E 8TH ST STE 3
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7120
Practice Address - Country:US
Practice Address - Phone:956-447-2668
Practice Address - Fax:956-973-0960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1991208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097127707Medicaid
TX0971277-09Medicaid
TX1T9072OtherPTAN
TX097127702Medicaid
TX0971277-10Medicaid