Healthcare Provider Details

I. General information

NPI: 1457062945
Provider Name (Legal Business Name): IRVING KING ESGUERRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 E FLAMINGO RD
LAS VEGAS NV
89119-5257
US

IV. Provider business mailing address

1641 E FLAMINGO RD STE 7
LAS VEGAS NV
89119-5257
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-4575
  • Fax: 702-485-4573
Mailing address:
  • Phone: 702-545-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number860646
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: