Provider Demographics
NPI:1164382503
Name:ESCAPA, NEVADA
Entity type:Individual
Prefix:
First Name:NEVADA
Middle Name:
Last Name:ESCAPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 N TIOGA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3539
Mailing Address - Country:US
Mailing Address - Phone:702-289-9052
Mailing Address - Fax:
Practice Address - Street 1:6535 N TIOGA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-3539
Practice Address - Country:US
Practice Address - Phone:702-289-9052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist