Healthcare Provider Details

I. General information

NPI: 1144844218
Provider Name (Legal Business Name): REBECCA E ESCOTO MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 1ST AVE
NEW YORK NY
10016-6512
US

IV. Provider business mailing address

3064 CREEK RD
PARK CITY UT
84098-4843
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-3346
  • Fax:
Mailing address:
  • Phone: 425-890-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58140
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: