Healthcare Provider Details

I. General information

NPI: 1306557608
Provider Name (Legal Business Name): RICARDO ALBERTO ESCOBAR III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 05/27/2025
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92350-1716
US

IV. Provider business mailing address

10830 PEPPER WAY
LOMA LINDA CA
92354-2500
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4013
  • Fax:
Mailing address:
  • Phone: 951-489-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberPA61978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: