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Rafael Espique Callanta

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

601 S Rancho Dr Ste A6, Las Vegas, NV 89106-4898

PECOS Enrollment

This provider is enrolled in PECOS as RAFAEL CALLANTA.

Based on the most recent information from CMS, provider Rafael Espique Callanta is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1881935237
Provider Type
Individual
Full Name
Callanta, Rafael Espique
Title
Mr.
Credential
NURSE PRACTITIONER

Gender
Male
Sole Proprietor
No
Enumeration Date
3/11/2013
Last Updated
4/12/2021

Contact Information

Practice Location

601 S Rancho Dr Ste A6, Las Vegas, NV 89106-4898

(702) 386-0909

(702) 386-0707

Mailing Location

1208 Hunt St, Las Vegas, NV 89146-1443

(702) 498-9417

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 001503 Nevada
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 700891 Nevada

Rafael Espique Callanta

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

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Description

License

Code

Description

License

Code

Description

License

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