Provider Demographics
NPI:1790758662
Name:ESQUIVEL, ROMEO (MD)
Entity Type:Individual
Prefix:
First Name:ROMEO
Middle Name:
Last Name:ESQUIVEL
Suffix:
Gender:M
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:PO BOX 43130
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3130
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:6130 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3557
Practice Address - Country:US
Practice Address - Phone:520-575-5003
Practice Address - Fax:520-297-3146
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29123207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ318126Medicaid
AZ711334Medicaid
AZZ121940Medicare PIN
AZH66091Medicare UPIN
AZ318126Medicaid