Provider Demographics
NPI:1356692164
Name:SANDRA A ESQUIVEL MD PA
Entity type:Organization
Organization Name:SANDRA A ESQUIVEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-447-2668
Mailing Address - Street 1:1330 E 6TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6608
Mailing Address - Country:US
Mailing Address - Phone:956-447-2668
Mailing Address - Fax:956-973-0960
Practice Address - Street 1:1330 E 6TH ST STE 201
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6608
Practice Address - Country:US
Practice Address - Phone:956-447-2668
Practice Address - Fax:956-973-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX97127702Medicaid
TX1053320713OtherNPI