Provider Demographics
NPI:1285292771
Name:ESCUETA, AIDA
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:
Last Name:ESCUETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AIDA FLAVIANA
Other - Middle Name:
Other - Last Name:ESCUETA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4059 ST REMY CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:394 E YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8218
Practice Address - Country:US
Practice Address - Phone:209-383-3990
Practice Address - Fax:209-383-2082
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily