Healthcare Provider Details

I. General information

NPI: 1639150410
Provider Name (Legal Business Name): CLAIRE ELLEN ESCAMILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S FM 1346 STE 2
LA VERNIA TX
78121-4282
US

IV. Provider business mailing address

113 VILLAGE CIR
SAN ANTONIO TX
78232-2821
US

V. Phone/Fax

Practice location:
  • Phone: 830-779-3200
  • Fax: 830-779-3211
Mailing address:
  • Phone: 210-843-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK3563
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2019-0842
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: