Healthcare Provider Details

I. General information

NPI: 1649137472
Provider Name (Legal Business Name): GREGORY ISSAC ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NEEDHAM ST
MODESTO CA
95354-0730
US

IV. Provider business mailing address

1001 NEEDHAM ST
MODESTO CA
95354-0730
US

V. Phone/Fax

Practice location:
  • Phone: 209-569-0373
  • Fax: 209-529-8519
Mailing address:
  • Phone: 209-569-0373
  • Fax: 209-529-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: