Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 292380 | CA |
NPI | 1013459817 |
---|---|
Provider Name | Luis Escamilla |
First Address | Riverside, CA 92507-0728 |
Second Address | Riverside, CA 92507-0728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2016 |
Last Update Date | 09/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
292380 | PT LICENSE (01) | CA |