Provider Demographics
NPI:1154980324
Name:ESCANILLAS, ROVEN CHINO OLAYRES
Entity type:Individual
Prefix:
First Name:ROVEN CHINO
Middle Name:OLAYRES
Last Name:ESCANILLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 LAVACA ST # 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1634
Mailing Address - Country:US
Mailing Address - Phone:512-566-4233
Mailing Address - Fax:
Practice Address - Street 1:13410 HARTLAND LAKE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-1345
Practice Address - Country:US
Practice Address - Phone:832-691-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily