Healthcare Provider Details

I. General information

NPI: 1053904045
Provider Name (Legal Business Name): DJOMELLE ESCANO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E 8TH ST
WESLACO TX
78596-6640
US

IV. Provider business mailing address

4224 N MCCOLL RD APT 1316
MCALLEN TX
78504-4670
US

V. Phone/Fax

Practice location:
  • Phone: 956-968-8567
  • Fax:
Mailing address:
  • Phone: 713-933-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1030510
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: