Healthcare Provider Details

I. General information

NPI: 1154980324
Provider Name (Legal Business Name): ROVEN CHINO OLAYRES ESCANILLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13410 HARTLAND LAKE LN
HOUSTON TX
77044-1345
US

IV. Provider business mailing address

1401 LAVACA ST # 35
AUSTIN TX
78701-1634
US

V. Phone/Fax

Practice location:
  • Phone: 832-691-4847
  • Fax:
Mailing address:
  • Phone: 512-566-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: