Healthcare Provider Details

I. General information

NPI: 1770756330
Provider Name (Legal Business Name): ANTONIO ENRIQUE ESCOBEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 WHITTIER BLVD SUITE 450
WHITTIER CA
90603-2347
US

IV. Provider business mailing address

15725 E. WHITTIER BLVD SUITE 450
WHITTIER CA
90603
US

V. Phone/Fax

Practice location:
  • Phone: 562-947-3307
  • Fax: 562-943-1090
Mailing address:
  • Phone: 562-947-3307
  • Fax: 562-943-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA95736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: