Healthcare Provider Details

I. General information

NPI: 1891246187
Provider Name (Legal Business Name): CELINA RUIZ ESCAMILLA MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 07/21/2022
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7734 N 59TH AVE
GLENDALE AZ
85301-7816
US

IV. Provider business mailing address

1533 E. WILLETTA ST.
PHOENIX AZ
85006
US

V. Phone/Fax

Practice location:
  • Phone: 602-569-3999
  • Fax: 602-569-3887
Mailing address:
  • Phone: 602-569-3999
  • Fax: 602-569-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9840
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: