Provider Demographics
NPI:1952709966
Name:ESCAMILLA, ROSY RENTERIA (SA-C)
Entity Type:Individual
Prefix:MISS
First Name:ROSY
Middle Name:RENTERIA
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 S HIGLEY RD STE 114-273
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5438
Mailing Address - Country:US
Mailing Address - Phone:480-326-3452
Mailing Address - Fax:
Practice Address - Street 1:3317 S HIGLEY RD STE 114-273
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-5438
Practice Address - Country:US
Practice Address - Phone:480-326-3452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14-590246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant