MEDICARE: OLIVIA ESCONDO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1508593252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA ESCONDO

Provider Business Mailing Address
First Line	:	5206 WILLOW CREEK OVERLOOK
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-4311
Country	:	US
Telephone Number	:	404-909-9181
Fax Number	:

Provider Business Practice Location Address
First Line	:	5206 WILLOW CREEK OVERLOOK
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-4311
Country	:	US
Telephone Number	:	404-909-9181
Fax Number	:

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

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	08/03/2022

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Directions to “ OLIVIA ESCONDO ” Practice Location

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