Healthcare Provider Details

I. General information

NPI: 1629412044
Provider Name (Legal Business Name): ANGELINA ESCANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 02/28/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR # 3600
SAN ANTONIO TX
78234-4501
US

IV. Provider business mailing address

1100 WILFORD HALL LOOP PEDIATRICS CLINIC
LACKLAND AFB TX
78236
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-9928
  • Fax:
Mailing address:
  • Phone: 210-292-7520
  • Fax: 210-292-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28289
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: