Healthcare Provider Details

I. General information

NPI: 1811121668
Provider Name (Legal Business Name): KRISTIN VALDERAS ESCAMILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 E BEN WHITE BLVD
AUSTIN TX
78741-7537
US

IV. Provider business mailing address

3501 MILLS AVE
AUSTIN TX
78731-6309
US

V. Phone/Fax

Practice location:
  • Phone: 512-804-3770
  • Fax:
Mailing address:
  • Phone: 512-324-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberBP1-0035467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: