Provider Demographics
NPI:1295983625
Name:TIBURCIO-ESPINOZA, VERONICA (PA)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:TIBURCIO-ESPINOZA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16026 CEDAR GULLY DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3183
Mailing Address - Country:US
Mailing Address - Phone:360-991-7260
Mailing Address - Fax:
Practice Address - Street 1:107 WOODLAWN DR STE 101
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3987
Practice Address - Country:US
Practice Address - Phone:832-783-1079
Practice Address - Fax:281-993-1200
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01410363A00000X
TXPA16256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500604294Medicaid
ORR181449Medicare PIN