Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1215597489 |
---|---|
Provider Name | Joshua Rafael Escalante |
First Address | Big Spring, TX 79720-4742 |
Second Address | Big Spring, TX 79720-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2019 |
Last Update Date | 19/06/2019 |