Healthcare Provider Details

I. General information

NPI: 1306522248
Provider Name (Legal Business Name): CARLA ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA LIZANO RUBIO

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 SW 38TH ST.
LAWTON OK
73505
US

IV. Provider business mailing address

602 SW 38TH ST.
LAWTON OK
73505
US

V. Phone/Fax

Practice location:
  • Phone: 580-248-5780
  • Fax:
Mailing address:
  • Phone: 580-248-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: