Healthcare Provider Details

I. General information

NPI: 1417338658
Provider Name (Legal Business Name): TATIANA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 ROGERS AVE APT 2
BROOKLYN NY
11225-5992
US

IV. Provider business mailing address

574 ROGERS AVE APT 2
BROOKLYN NY
11225-5992
US

V. Phone/Fax

Practice location:
  • Phone: 917-808-1017
  • Fax:
Mailing address:
  • Phone: 917-808-1017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: