1720438104 NPI number — MR. RODNEY YSA MESQUIAS FNP-C

Table of content: MR. RODNEY YSA MESQUIAS FNP-C (NPI 1720438104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720438104 NPI number — MR. RODNEY YSA MESQUIAS FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESQUIAS
Provider First Name:
RODNEY
Provider Middle Name:
YSA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1720438104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26007 AVELLINO BLF
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78261-2580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-805-5650
Provider Business Mailing Address Fax Number:
512-392-4718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6018 WEST AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
CASTLE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-860-0129
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2016

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: 363LF0000X , with the licence number:  AP131165 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AP131165 . This is a "NURSE PRACTITIONER - FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 813910 . This is a "RN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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