Healthcare Provider Details

I. General information

NPI: 1487885695
Provider Name (Legal Business Name): SAMUEL ANDREW ESCARSEGA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NMCSD
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

1030 ROBINSON AVE 209
SAN DIEGO CA
92103-4446
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8250
  • Fax:
Mailing address:
  • Phone: 210-601-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number24674
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: