Healthcare Provider Details

I. General information

NPI: 1821605692
Provider Name (Legal Business Name): YOHALMO ESAU ESCOBAR LEIVA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR
MARTINSBURG WV
25401-3402
US

IV. Provider business mailing address

167 SPYGLASS DR
MARTINSBURG WV
25403-1397
US

V. Phone/Fax

Practice location:
  • Phone: 304-264-1000
  • Fax:
Mailing address:
  • Phone: 703-365-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number104822
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: