Provider Demographics
NPI:1104675586
Name:LAXAMANA, AIRRA LOUISE ESCARIO
Entity type:Individual
Prefix:
First Name:AIRRA LOUISE
Middle Name:ESCARIO
Last Name:LAXAMANA
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 1:1465 CIVIC CT
Mailing Address - Street 2:STE D
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520
Mailing Address - Country:US
Mailing Address - Phone:925-678-5230
Mailing Address - Fax:
Practice Address - Street 1:5461 PREWETT RANCH DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8717
Practice Address - Country:US
Practice Address - Phone:650-307-9497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95222003163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse