Provider Demographics
NPI:1881935237
Name:CALLANTA, RAFAEL ESPIQUE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:ESPIQUE
Last Name:CALLANTA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1208 HUNT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1443
Mailing Address - Country:US
Mailing Address - Phone:702-498-9417
Mailing Address - Fax:
Practice Address - Street 1:601 S RANCHO DR STE A6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4898
Practice Address - Country:US
Practice Address - Phone:702-386-0909
Practice Address - Fax:702-386-0707
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV700891363L00000X
NV001503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner