Individual
MR. ESTEBAN E ESCANUELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EIS-FQP
Contact information
Practice address
612 S IRENE ST, SAN ANGELO, TX 76903-6629
(325) 658-6571
Mailing address
PO BOX 5199, SAN ANGELO, TX 76902-5199
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
083226
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396867966
—
TX
Enumeration date
01/24/2011
Last updated
01/24/2011
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