Provider Demographics
NPI:1124755467
Name:ESCALANTE VARGAS, ELBER (FNP-C)
Entity type:Individual
Prefix:
First Name:ELBER
Middle Name:
Last Name:ESCALANTE VARGAS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-2823
Mailing Address - Country:US
Mailing Address - Phone:510-974-6914
Mailing Address - Fax:
Practice Address - Street 1:2625 MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-2823
Practice Address - Country:US
Practice Address - Phone:510-974-6914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022028363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner