Provider Demographics
NPI:1821605692
Name:ESCOBAR LEIVA, YOHALMO ESAU (RN)
Entity Type:Individual
Prefix:
First Name:YOHALMO
Middle Name:ESAU
Last Name:ESCOBAR LEIVA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 SPYGLASS DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-1397
Mailing Address - Country:US
Mailing Address - Phone:703-365-5811
Mailing Address - Fax:
Practice Address - Street 1:2500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3402
Practice Address - Country:US
Practice Address - Phone:304-264-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVF964955OtherAPPLYING FOR FEDERAL JOB RN AT THE VA