Healthcare Provider Details

I. General information

NPI: 1053320713
Provider Name (Legal Business Name): SANDRA ESQUIVEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 E 8TH ST STE 3
WESLACO TX
78596-7120
US

IV. Provider business mailing address

367 S GULPH RD
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 956-447-2668
  • Fax: 956-973-0960
Mailing address:
  • Phone: 956-447-2668
  • Fax: 956-229-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberJ1991
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: