Healthcare Provider Details

I. General information

NPI: 1073335527
Provider Name (Legal Business Name): JUAN JOSE ESCOBEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10233 E NORTHWEST HWY STE 436
DALLAS TX
75238-4418
US

IV. Provider business mailing address

10233 E NORTHWEST HWY STE 436
DALLAS TX
75238-4418
US

V. Phone/Fax

Practice location:
  • Phone: 855-782-7822
  • Fax:
Mailing address:
  • Phone: 855-782-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-292083
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: