MEDICARE: DR. EFREN ESCUETA RECTO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5438	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790841831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EFREN ESCUETA RECTO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 98978
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8978
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:	702-671-6883

Provider Business Practice Location Address
First Line	:	2831 BUSINESS PARK CT
Second Line	:	130
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9000
Country	:	US
Telephone Number	:	702-240-0088
Fax Number	:	702-240-3049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	08/06/2015

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