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General NPI Number Information
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NPI Number | 1972495174
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Entity Type | Organization
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Legal Business Name | JAVIER EZQUERRA GOMEZ
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | JAVIER EZQUERR GOMEZ HIDALGO 148B
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City | CHAPALA
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State | JALSICO
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Zip | 45922
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Country | MX
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Telephone | 888-449-7799
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Fax |
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Provider Business Mailing Address
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Address Line | 5830 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82609-4308
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Country | US
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Telephone | 800-345-2703
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAVIER EZQUERRA GOMEZ
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Credential | MD
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Telephone | 800-345-2703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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