Healthcare Provider Details

I. General information

NPI: 1770247249
Provider Name (Legal Business Name): AYEISHA ESCARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 09/28/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. COMERIO 610 (MARGINAL) DENTRO SUPERMERCADO ECONO, LEVITOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

AVE. COMERIO 610 (MARGINAL) DENTRO SUPERMERCADO ECONO, LEVITOWN
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 939-625-3502
  • Fax:
Mailing address:
  • Phone: 939-625-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23018
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15791-I
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: