1437206836 NPI number — DR. CARLOS L ESQUIVIA-MUNOZ MD, PA

Table of content: DR. CARLOS L ESQUIVIA-MUNOZ MD, PA (NPI 1437206836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437206836 NPI number — DR. CARLOS L ESQUIVIA-MUNOZ MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESQUIVIA-MUNOZ
Provider First Name:
CARLOS
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437206836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1895 KINGSLEY AVE STE 701
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-4410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-272-2525
Provider Business Mailing Address Fax Number:
904-272-2700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1895 KINGSLEY AVE STE 701
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-272-2525
Provider Business Practice Location Address Fax Number:
904-272-2700
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  ME 21696 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F10900710 . This is a "TRICARE PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10708502 . This is a "CIGNA - PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59-1704089 . This is a "HUMANA PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PR02459 . This is a "QUALITY HEALTH PLAN PN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10071 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0582484-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59-1704089 . This is a "MISC. INSURANCE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 40121 . This is a "AV-MED PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2209195 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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