Healthcare Provider Details

I. General information

NPI: 1073809893
Provider Name (Legal Business Name): PEDRO ARCENIO ESCOBAR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 6TH ST
ORANGE COVE CA
93646-2136
US

IV. Provider business mailing address

555 6TH ST
ORANGE COVE CA
93646-2505
US

V. Phone/Fax

Practice location:
  • Phone: 559-626-7118
  • Fax:
Mailing address:
  • Phone: 559-356-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: