Healthcare Provider Details

I. General information

NPI: 1285292771
Provider Name (Legal Business Name): AIDA ESCUETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIDA FLAVIANA ESCUETA

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 E YOSEMITE AVE
MERCED CA
95340-8218
US

IV. Provider business mailing address

4059 ST REMY CT
MERCED CA
95348-9541
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-3990
  • Fax: 209-383-2082
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: