Healthcare Provider Details

I. General information

NPI: 1659701472
Provider Name (Legal Business Name): PAUL ESCORZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E 9TH AVE STE 190
DENVER CO
80203-2744
US

IV. Provider business mailing address

1135 BROADWAY APT. 808
DENVER CO
80203
US

V. Phone/Fax

Practice location:
  • Phone: 720-436-6344
  • Fax:
Mailing address:
  • Phone: 720-436-6344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0004164
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: