Healthcare Provider Details

I. General information

NPI: 1538922901
Provider Name (Legal Business Name): LEONARDO ESQUIVEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 E GRIFFIN PKWY # 8
MISSION TX
78572-2416
US

IV. Provider business mailing address

7708 WAGON TRAIL DR
MISSION TX
78572-7960
US

V. Phone/Fax

Practice location:
  • Phone: 956-424-3433
  • Fax:
Mailing address:
  • Phone: 956-862-9946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16795
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: