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NPI Code Detail

MEDICARE: MR. RAFAEL ESPIQUE CALLANTA NURSE PRACTITIONER

MEDICARE: MR. RAFAEL ESPIQUE CALLANTA NURSE PRACTITIONER
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
1363L00000XNurse Practitioner700891NV
2363LF0000XFamily Nurse Practitioner001503NV

General Provider Information

NPI Number : 1881935237
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RAFAEL ESPIQUE CALLANTA NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 1208 HUNT ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1443
Country : US
Telephone Number : 702-498-9417
Fax Number :
Provider Business Practice Location Address
First Line : 601 S RANCHO DR STE A6
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4898
Country : US
Telephone Number : 702-386-0909
Fax Number : 702-386-0707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2013
Last Update Date : 04/12/2021

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