Provider Demographics
NPI:1487266086
Name:ESPARZA, GRACE MONIQUE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MONIQUE
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10457 AAKER ST
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-4634
Mailing Address - Country:US
Mailing Address - Phone:915-630-9950
Mailing Address - Fax:
Practice Address - Street 1:3913 BROADDUS AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-5503
Practice Address - Country:US
Practice Address - Phone:915-852-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16729363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program