Healthcare Provider Details

I. General information

NPI: 1013271394
Provider Name (Legal Business Name): CYNTHIA ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S EASTERN AVE STE 200
LAS VEGAS NV
89119-6137
US

IV. Provider business mailing address

721 SPONSELLER ST
LAS VEGAS NV
89110-2389
US

V. Phone/Fax

Practice location:
  • Phone: 702-451-7542
  • Fax: 702-450-4239
Mailing address:
  • Phone: 702-771-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: