Healthcare Provider Details

I. General information

NPI: 1588214662
Provider Name (Legal Business Name): SHANIKA ESCOCHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615A GALE ST
LAREDO TX
78041-5955
US

IV. Provider business mailing address

615A GALE ST
LAREDO TX
78041-5955
US

V. Phone/Fax

Practice location:
  • Phone: 956-712-9988
  • Fax:
Mailing address:
  • Phone: 956-712-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number343319
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: