Healthcare Provider Details

I. General information

NPI: 1598012809
Provider Name (Legal Business Name): GRACE VALENTON ESGUERRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 CARMEN BOULEVARD
LAS VEGAS NV
89128
US

IV. Provider business mailing address

3305 MARCEL CT
SAN JOSE CA
95135-1158
US

V. Phone/Fax

Practice location:
  • Phone: 408-828-1769
  • Fax: 408-440-0920
Mailing address:
  • Phone: 408-828-1769
  • Fax: 408-440-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN41086
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: