Healthcare Provider Details

I. General information

NPI: 1134919772
Provider Name (Legal Business Name): EIDER JESUS ESCORCIA-SUAREZ LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 N SHEPHERD DR APT 2413
HOUSTON TX
77018-2276
US

IV. Provider business mailing address

4840 N SHEPHERD DR APT 2413
HOUSTON TX
77018-2276
US

V. Phone/Fax

Practice location:
  • Phone: 347-617-8893
  • Fax:
Mailing address:
  • Phone: 347-617-8893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT144811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: