Provider Demographics
NPI:1437206836
Name:ESQUIVIA-MUNOZ, CARLOS L (MD, PA)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:L
Last Name:ESQUIVIA-MUNOZ
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 KINGSLEY AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4410
Mailing Address - Country:US
Mailing Address - Phone:904-272-2525
Mailing Address - Fax:904-272-2700
Practice Address - Street 1:1895 KINGSLEY AVE STE 701
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4410
Practice Address - Country:US
Practice Address - Phone:904-272-2525
Practice Address - Fax:904-272-2700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 21696207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF10900710OtherTRICARE PROVIDER NUMBER
FL10708502OtherCIGNA - PROVIDER NUMBER
FL59-1704089OtherHUMANA PROVIDER NUMBER
FLPR02459OtherQUALITY HEALTH PLAN PN
FL10071OtherBCBS PROVIDER NUMBER
FL0582484-00Medicaid
FL59-1704089OtherMISC. INSURANCE ID
FL40121OtherAV-MED PROVIDER NUMBER
FL2209195OtherAETNA PROVIDER NUMBER
FL59-1704089OtherMISC. INSURANCE ID
FLD85003Medicare UPIN