Healthcare Provider Details

I. General information

NPI: 1427222363
Provider Name (Legal Business Name): MARLO ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLO VEGA

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 OLD ALICE RD SUITE 600
BROWNSVILLE TX
78520-8268
US

IV. Provider business mailing address

871 OLD ALICE RD SUITE 600
BROWNSVILLE TX
78520-8268
US

V. Phone/Fax

Practice location:
  • Phone: 956-542-7587
  • Fax: 956-542-7597
Mailing address:
  • Phone: 956-542-7587
  • Fax: 956-542-7597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number40316
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: