Healthcare Provider Details

I. General information

NPI: 1881249506
Provider Name (Legal Business Name): SANTIAGO ESCAJEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 PAREDES LINE RD
BROWNSVILLE TX
78521-2483
US

IV. Provider business mailing address

535 PAREDES LINE RD
BROWNSVILLE TX
78521-2483
US

V. Phone/Fax

Practice location:
  • Phone: 956-982-8907
  • Fax: 956-982-0436
Mailing address:
  • Phone: 956-982-8907
  • Fax: 956-982-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1251600
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: