Healthcare Provider Details

I. General information

NPI: 1124996137
Provider Name (Legal Business Name): ANDREW JOSE ESCOBEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 HOWARD HUGHES PKWY STE 300
LAS VEGAS NV
89169-0946
US

IV. Provider business mailing address

3011 SUNFISH DR UNIT B
HENDERSON NV
89014-0291
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-2192
  • Fax: 702-560-2192
Mailing address:
  • Phone: 725-247-9771
  • Fax: 725-247-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: