Provider Demographics
NPI:1649824921
Name:ESCAMILLA MARTINEZ, JOEL OMAR
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:OMAR
Last Name:ESCAMILLA MARTINEZ
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 1:3580 E ALEXANDER RD APT 1039
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0292
Mailing Address - Country:US
Mailing Address - Phone:559-408-1045
Mailing Address - Fax:
Practice Address - Street 1:3688 HIDDEN BEACH CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-1285
Practice Address - Country:US
Practice Address - Phone:702-704-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst