Healthcare Provider Details

I. General information

NPI: 1619271244
Provider Name (Legal Business Name): MR. WILFREDO COMIA ESCARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 STOCKTON BLVD
SACRAMENTO CA
95817-1337
US

IV. Provider business mailing address

7848 IVY HILL WAY
ANTELOPE CA
95843-2469
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-4888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN148479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: