Healthcare Provider Details

I. General information

NPI: 1649881806
Provider Name (Legal Business Name): RAMIRO ESCALERA PT STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

121 ADAMS ST NW # A
WASHINGTON DC
20001-1610
US

V. Phone/Fax

Practice location:
  • Phone: 240-898-4404
  • Fax:
Mailing address:
  • Phone: 617-455-8552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: