Healthcare Provider Details

I. General information

NPI: 1477765188
Provider Name (Legal Business Name): VICTOR JOSUAN ESCRIBANO MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 639 KM 4.8
SABANA HOYOS PR
00688-1364
US

IV. Provider business mailing address

PO BOX 1364
SABANA HOYOS PR
00688-1364
US

V. Phone/Fax

Practice location:
  • Phone: 939-717-4962
  • Fax:
Mailing address:
  • Phone: 939-717-4962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number6451
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: