MEDICARE: DIANA ESCOBEDO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	RS2016-0546	NM

General Provider Information

NPI Number	:	1104278795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA ESCOBEDO M.D.

Provider Business Mailing Address
First Line	:	2450 S TELSHOR BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-5069
Country	:	US
Telephone Number	:	575-521-5385
Fax Number	:

Provider Business Practice Location Address
First Line	:	494 N KENAZO AVE STE I-J
Second Line	:
City	:	HORIZON CITY
State	:	TX
Zip	:	79928-5419
Country	:	US
Telephone Number	:	575-521-5385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	10/07/2019

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Directions to “ DIANA ESCOBEDO M.D.” Practice Location

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