Healthcare Provider Details

I. General information

NPI: 1013807791
Provider Name (Legal Business Name): SEBASTIAN ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15116 N COTTON LN
SURPRISE AZ
85388-9618
US

IV. Provider business mailing address

15116 N COTTON LN
SURPRISE AZ
85388-9618
US

V. Phone/Fax

Practice location:
  • Phone: 602-284-0959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: