Healthcare Provider Details

I. General information

NPI: 1245143726
Provider Name (Legal Business Name): RAFAEL ESCOBEDO QUIROZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 KANEVILLE RD
GENEVA IL
60134-2578
US

IV. Provider business mailing address

1433 STAR GRASS CIR
AURORA IL
60506-6517
US

V. Phone/Fax

Practice location:
  • Phone: 855-386-7846
  • Fax:
Mailing address:
  • Phone: 630-881-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.036542
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: