Provider Demographics
NPI:1841379518
Name:RAFAEL C ESQUENAZI MD PA
Entity Type:Organization
Organization Name:RAFAEL C ESQUENAZI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESQUENAZI
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:713-637-6320
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:STEWART
Mailing Address - State:TN
Mailing Address - Zip Code:37175-0080
Mailing Address - Country:US
Mailing Address - Phone:713-637-6320
Mailing Address - Fax:713-637-0735
Practice Address - Street 1:15634 WALLISVILLE RD # 339
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4635
Practice Address - Country:US
Practice Address - Phone:713-637-6320
Practice Address - Fax:713-637-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124363602Medicaid
TX042982102Medicaid
TX123321501Medicaid
TXH14717Medicare UPIN
TX00281NMedicare PIN
TXB22573Medicare UPIN
TX123321501Medicaid