Healthcare Provider Details

I. General information

NPI: 1992562524
Provider Name (Legal Business Name): JANALLE LOREN ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 E RUSSELL RD
LAS VEGAS NV
89120-2426
US

IV. Provider business mailing address

2715 E RUSSELL RD
LAS VEGAS NV
89120-2426
US

V. Phone/Fax

Practice location:
  • Phone: 725-238-4115
  • Fax:
Mailing address:
  • Phone: 725-238-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT3315
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: