Healthcare Provider Details

I. General information

NPI: 1649824921
Provider Name (Legal Business Name): JOEL OMAR ESCAMILLA MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3688 HIDDEN BEACH CT
LAS VEGAS NV
89115-1285
US

IV. Provider business mailing address

3580 E ALEXANDER RD APT 1039
LAS VEGAS NV
89115-0292
US

V. Phone/Fax

Practice location:
  • Phone: 702-704-9465
  • Fax:
Mailing address:
  • Phone: 559-408-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: