Healthcare Provider Details

I. General information

NPI: 1508154147
Provider Name (Legal Business Name): SAMUEL ESQUIVEL QRP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10421 GULFDALE ST
SAN ANTONIO TX
78216-4130
US

IV. Provider business mailing address

10421 GULFDALE ST
SAN ANTONIO TX
78216-4130
US

V. Phone/Fax

Practice location:
  • Phone: 210-240-3306
  • Fax: 210-366-1236
Mailing address:
  • Phone: 210-240-3306
  • Fax: 210-366-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: