Healthcare Provider Details

I. General information

NPI: 1588488589
Provider Name (Legal Business Name): CAROLINA ESCARSEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 LOWENSTEIN AVE
EL PASO TX
79907-6537
US

IV. Provider business mailing address

392 VILLA SOL CT
SOCORRO TX
79927-3081
US

V. Phone/Fax

Practice location:
  • Phone: 915-408-2126
  • Fax:
Mailing address:
  • Phone: 915-408-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberLHOC24-00077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: