Healthcare Provider Details

I. General information

NPI: 1184586299
Provider Name (Legal Business Name): JUAN FRANCISCO ESCOBAR JR. IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

34800 BOB WILSON DR
FPO AA
92134
US

V. Phone/Fax

Practice location:
  • Phone: 484-629-4157
  • Fax:
Mailing address:
  • Phone: 484-629-4157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License NumberY4243358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: