Healthcare Provider Details

I. General information

NPI: 1093499147
Provider Name (Legal Business Name): MR. FAUSTINO ESCARENO III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4147 PALMER MEADOW CT
KATY TX
77494-2342
US

IV. Provider business mailing address

4147 PALMER MEADOW CT
KATY TX
77494-2342
US

V. Phone/Fax

Practice location:
  • Phone: 832-920-0928
  • Fax:
Mailing address:
  • Phone: 832-920-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: