Healthcare Provider Details

I. General information

NPI: 1578096038
Provider Name (Legal Business Name): MR. LEONARDO PITER ESCALANTE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 W MAIN ST STE F
BRAWLEY CA
92227-2202
US

IV. Provider business mailing address

251 W MAIN ST STE F
BRAWLEY CA
92227-2202
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-9460
  • Fax: 760-351-9477
Mailing address:
  • Phone: 760-351-9466
  • Fax: 760-351-9477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: