Provider Demographics
NPI:1962074138
Name:DIAZ ESCOBAR, SANTA CECILIA
Entity type:Individual
Prefix:
First Name:SANTA
Middle Name:CECILIA
Last Name:DIAZ ESCOBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANTA
Other - Middle Name:CECILIA
Other - Last Name:DIAZ ESCOBAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4525 S SANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4525 S SANDHILL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5954
Practice Address - Country:US
Practice Address - Phone:702-954-4087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant