Healthcare Provider Details

I. General information

NPI: 1538265913
Provider Name (Legal Business Name): JUANA MARIA ESPEJO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 S CAGE BLVD
PHARR TX
78577-6716
US

IV. Provider business mailing address

PO BOX 1590
PHARR TX
78577-1627
US

V. Phone/Fax

Practice location:
  • Phone: 956-212-6486
  • Fax: 956-702-6911
Mailing address:
  • Phone: 956-212-6486
  • Fax: 956-702-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License NumberM0715
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM0715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: