Healthcare Provider Details

I. General information

NPI: 1083754337
Provider Name (Legal Business Name): ERNESTO ENRIQUE ESCALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5723 E 5TH ST
TUCSON AZ
85711-2401
US

IV. Provider business mailing address

5200 W CRESTVIEW DR
TUCSON AZ
85745-8926
US

V. Phone/Fax

Practice location:
  • Phone: 520-514-7400
  • Fax: 520-514-7403
Mailing address:
  • Phone: 520-743-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3429
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: