Healthcare Provider Details

I. General information

NPI: 1174842652
Provider Name (Legal Business Name): RICARDO ESCOBEDO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 S 8TH ST STE. A
EL CENTRO CA
92243-2903
US

IV. Provider business mailing address

343 S 8TH ST STE. A
EL CENTRO CA
92243-2903
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-6151
  • Fax: 760-353-6152
Mailing address:
  • Phone: 760-353-6151
  • Fax: 760-353-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: