Healthcare Provider Details

I. General information

NPI: 1922185164
Provider Name (Legal Business Name): MAYRA ELIZABETH ESCOBAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BIRCH ST STE #3
REDWOOD CITY CA
94062
US

IV. Provider business mailing address

642 PARKVIEW CIRCLE
PACIFICA CA
94044-1528
US

V. Phone/Fax

Practice location:
  • Phone: 650-261-9834
  • Fax: 650-261-9835
Mailing address:
  • Phone: 650-451-8206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: