Healthcare Provider Details

I. General information

NPI: 1760709455
Provider Name (Legal Business Name): MONICA ISABEL ESCAMILLA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

414 E GLENVIEW DR
SAN ANTONIO TX
78201-6629
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax:
Mailing address:
  • Phone: 210-386-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number001245
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: