Healthcare Provider Details

I. General information

NPI: 1780497107
Provider Name (Legal Business Name): SOCCORRO CARMEN ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 S EASTERN AVE STE 30
LAS VEGAS NV
89119-6100
US

IV. Provider business mailing address

4580 S EASTERN AVE STE 30
LAS VEGAS NV
89119-6100
US

V. Phone/Fax

Practice location:
  • Phone: 702-954-4087
  • Fax:
Mailing address:
  • Phone: 702-954-4087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: