Provider Demographics
NPI:1992753701
Name:ESPARZA, FERNANDO JESUS (PSY D)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:JESUS
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 SAN PEDRO AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2253
Mailing Address - Country:US
Mailing Address - Phone:210-403-2050
Mailing Address - Fax:210-403-9890
Practice Address - Street 1:16500 SAN PEDRO AVE STE 215
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2253
Practice Address - Country:US
Practice Address - Phone:210-403-2050
Practice Address - Fax:210-403-9890
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113491802Medicaid
TX00403EMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER