Healthcare Provider Details

I. General information

NPI: 1235780412
Provider Name (Legal Business Name): LUCY ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 S MARYLAND PKWY STE 512A
LAS VEGAS NV
89109-1568
US

IV. Provider business mailing address

2770 S MARYLAND PKWY STE 512A
LAS VEGAS NV
89109-1568
US

V. Phone/Fax

Practice location:
  • Phone: 702-917-1402
  • Fax:
Mailing address:
  • Phone: 702-917-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: