Healthcare Provider Details

I. General information

NPI: 1437206836
Provider Name (Legal Business Name): CARLOS L ESQUIVIA-MUNOZ MD, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 KINGSLEY AVE STE 701
ORANGE PARK FL
32073-4410
US

IV. Provider business mailing address

1895 KINGSLEY AVE STE 701
ORANGE PARK FL
32073-4410
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-2525
  • Fax: 904-272-2700
Mailing address:
  • Phone: 904-272-2525
  • Fax: 904-272-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME 21696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: