Healthcare Provider Details

I. General information

NPI: 1265740351
Provider Name (Legal Business Name): TERESA ESQUIVEL-ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 STABLE DOWNS
SAN ANTONIO TX
78249-4609
US

IV. Provider business mailing address

6311 STABLE DOWNS
SAN ANTONIO TX
78249-4609
US

V. Phone/Fax

Practice location:
  • Phone: 210-641-5462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18934
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: