Healthcare Provider Details

I. General information

NPI: 1801232632
Provider Name (Legal Business Name): MERCEDITA R. ESCOBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 KAREN CT #514
LAS VEGAS NV
89109-1221
US

IV. Provider business mailing address

2647 KAREN CT #514
LAS VEGAS NV
89109-1221
US

V. Phone/Fax

Practice location:
  • Phone: 702-610-7552
  • Fax: 702-369-5605
Mailing address:
  • Phone: 702-610-7552
  • Fax: 702-369-5605

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: