Healthcare Provider Details

I. General information

NPI: 1376344119
Provider Name (Legal Business Name): NIXON ESCOBAR MHC-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NIXON ALEXNADER JARA MHC-I

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 38TH ST FL 16
NEW YORK NY
10018-9514
US

IV. Provider business mailing address

905 43RD ST APT A5
BROOKLYN NY
11219-1722
US

V. Phone/Fax

Practice location:
  • Phone: 332-249-1911
  • Fax: 332-265-0277
Mailing address:
  • Phone: 646-884-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: