Healthcare Provider Details

I. General information

NPI: 1104675586
Provider Name (Legal Business Name): AIRRA LOUISE ESCARIO LAXAMANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5461 PREWETT RANCH DR
ANTIOCH CA
94531-8717
US

IV. Provider business mailing address

1465 CIVIC CT STE D
CONCORD CA
94520
US

V. Phone/Fax

Practice location:
  • Phone: 650-307-9497
  • Fax:
Mailing address:
  • Phone: 925-678-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95222003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: