Healthcare Provider Details

I. General information

NPI: 1922215185
Provider Name (Legal Business Name): JAVIER PONCE ESCALERA M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 MANCHACA RD SUITE 202
AUSTIN TX
78704-6631
US

IV. Provider business mailing address

583 YORKS XING
DRIFTWOOD TX
78619-5759
US

V. Phone/Fax

Practice location:
  • Phone: 512-557-0947
  • Fax:
Mailing address:
  • Phone: 512-722-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA95344
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM7169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: