Healthcare Provider Details

I. General information

NPI: 1609475938
Provider Name (Legal Business Name): KAYLA NAOMI ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE
ALBUQUERQUE NM
87102-2360
US

IV. Provider business mailing address

3301 CANDELARIA RD NE STE B
ALBUQUERQUE NM
87107-1965
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-8471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-0606
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: