Healthcare Provider Details

I. General information

NPI: 1003063389
Provider Name (Legal Business Name): MARIA T ESCOBAR CSP, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

13226 N 3RD AVE
PHOENIX AZ
85029-1803
US

V. Phone/Fax

Practice location:
  • Phone: 480-440-2787
  • Fax:
Mailing address:
  • Phone: 480-440-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number927780
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: