1780246942 NPI number — ESPERANZA EATING DISORDERS CENTER, PLLC

Table of content: MR. GLENN JD MOLLOY ARNP (NPI 1033133780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780246942 NPI number — ESPERANZA EATING DISORDERS CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESPERANZA EATING DISORDERS CENTER, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ESPERANZA EATING DISORDERS CENTER
Provider Other Organization Name Type Code:
3
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:
1780246942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 HEIMER RD.
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78232-5032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-253-9763
Provider Business Mailing Address Fax Number:
210-255-1681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 HEIMER RD.
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78232-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-253-9763
Provider Business Practice Location Address Fax Number:
210-255-1681
Provider Enumeration Date:
07/08/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MENGDEN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO, CHIEF CLINICAL DIRECTOR
Authorized Official Telephone Number:
210-253-9763

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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