Healthcare Provider Details

I. General information

NPI: 1942430228
Provider Name (Legal Business Name): ESPERANZA M PIMENTEL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 CHAMBERS RD
SAINT LOUIS MO
63136-5546
US

IV. Provider business mailing address

2323 CHAMBERS RD
SAINT LOUIS MO
63136-5546
US

V. Phone/Fax

Practice location:
  • Phone: 314-867-3890
  • Fax: 314-867-2736
Mailing address:
  • Phone: 314-867-3890
  • Fax: 314-867-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number33313
License Number StateMO

VIII. Authorized Official

Name: DR. ESPERANZA M PIMENTEL
Title or Position: PRESIDENT
Credential: MD
Phone: 314-867-3890