Healthcare Provider Details

I. General information

NPI: 1144790643
Provider Name (Legal Business Name): ELAINE ESGUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 W. SAHARA AVE.
LAS VEGAS NV
89117
US

IV. Provider business mailing address

9320 W. SAHARA AVE.
LAS VEGAS NV
89117
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-3633
  • Fax: 702-562-2810
Mailing address:
  • Phone: 702-383-3633
  • Fax: 702-562-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number835273
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: