Healthcare Provider Details

I. General information

NPI: 1811194012
Provider Name (Legal Business Name): MARIA VICTORIA ESCAMILLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 GULF FWY S
LEAGUE CITY TX
77573-5143
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-1234
  • Fax:
Mailing address:
  • Phone: 409-772-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number509270
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP107243
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: