Healthcare Provider Details

I. General information

NPI: 1013499508
Provider Name (Legal Business Name): NANCY ALONDRA ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 S ALAMO RD
ALAMO TX
78516
US

IV. Provider business mailing address

11246 DEVAN DR
MISSION TX
78573-1418
US

V. Phone/Fax

Practice location:
  • Phone: 956-715-8600
  • Fax:
Mailing address:
  • Phone: 956-319-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number210268
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: