Healthcare Provider Details

I. General information

NPI: 1881417251
Provider Name (Legal Business Name): RACHEL ESCOBAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 HARPER AVE
SAINT CLAIR SHORES MI
48081-1971
US

IV. Provider business mailing address

6363 29 MILE RD
WASHINGTON MI
48095-2401
US

V. Phone/Fax

Practice location:
  • Phone: 248-726-7646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4704289952
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: