Provider Demographics
NPI:1457838138
Name:ESPARZA, JOHN PAUL (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9513 EL MANEADO RD
Mailing Address - Street 2:
Mailing Address - City:LYFORD
Mailing Address - State:TX
Mailing Address - Zip Code:78569-2114
Mailing Address - Country:US
Mailing Address - Phone:956-398-1108
Mailing Address - Fax:
Practice Address - Street 1:9513 EL MANEADO RD
Practice Address - Street 2:
Practice Address - City:LYFORD
Practice Address - State:TX
Practice Address - Zip Code:78569-2114
Practice Address - Country:US
Practice Address - Phone:956-398-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334317164X00000X
TX951822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790847531Medicaid