Healthcare Provider Details

I. General information

NPI: 1669588562
Provider Name (Legal Business Name): ENRIQUE ESCOBAR-MEDINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIMA PLAZA #1 SUITE # 703
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 8637
CAGUAS PR
00726-8637
US

V. Phone/Fax

Practice location:
  • Phone: 787-744-8315
  • Fax: 787-746-4311
Mailing address:
  • Phone: 787-744-8315
  • Fax: 787-746-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number12070
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: