Healthcare Provider Details

I. General information

NPI: 1700274743
Provider Name (Legal Business Name): JACOB ESQUENAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3153 E WARM SPRINGS #300
LAS VEGAS NV
89120
US

IV. Provider business mailing address

3153 E WARM SPRINGS #300
LAS VEGAS NV
89120
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-6510
  • Fax: 702-405-7960
Mailing address:
  • Phone: 702-487-6510
  • Fax: 702-405-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number17120
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: