Healthcare Provider Details

I. General information

NPI: 1346123247
Provider Name (Legal Business Name): TANYA G. ESCOBAR RN, MSN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 TECHNOLOGY DR
FREMONT CA
94538-6337
US

IV. Provider business mailing address

4210 TECHNOLOGY DR
FREMONT CA
94538-6337
US

V. Phone/Fax

Practice location:
  • Phone: 510-364-1180
  • Fax:
Mailing address:
  • Phone: 510-364-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number210004735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: