Provider Demographics
NPI:1861901282
Name:ESCALANTE, RUDOLPH VINCENT
Entity type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:VINCENT
Last Name:ESCALANTE
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 1:200 7TH AVENUE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062
Mailing Address - Country:US
Mailing Address - Phone:831-462-1060
Mailing Address - Fax:831-462-4970
Practice Address - Street 1:200 7TH AVENUE
Practice Address - Street 2:SUITE 150
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062
Practice Address - Country:US
Practice Address - Phone:831-462-1060
Practice Address - Fax:831-462-4970
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4410Medicaid
CA4496Medicaid