Provider Demographics
NPI:1457357386
Name:FERNANDEZ, ESPERANZA (MDPA)
Entity Type:Individual
Prefix:DR
First Name:ESPERANZA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5349 LAMPASAS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6226
Mailing Address - Country:US
Mailing Address - Phone:713-355-2161
Mailing Address - Fax:
Practice Address - Street 1:12322 EAST FWY
Practice Address - Street 2:STE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5532
Practice Address - Country:US
Practice Address - Phone:713-453-1238
Practice Address - Fax:713-453-2956
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2008-06-06
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TXJ9021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133434401Medicaid
TX00925GMedicare PIN
TX133434401Medicaid