Basic Information
| Provider Information | |||||||||
| NPI: | 1114404548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESCAMILLA MEZA | ||||||||
| FirstName: | AMAIRANY | ||||||||
| MiddleName: | MADAI | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7817 FAIRWEST CT | ||||||||
| Address2: | |||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761827330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177701288 | ||||||||
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| Practice Location | |||||||||
| Address1: | 410 E PIONEER PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | GRAND PRAIRIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750514984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4697331890 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2018 | ||||||||
| LastUpdateDate: | 11/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA12075 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.