Healthcare Provider Details

I. General information

NPI: 1225860695
Provider Name (Legal Business Name): CRISELDA ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 CENTER POINT DR
EDINBURG TX
78539-4804
US

IV. Provider business mailing address

11016 N 102ND ST
MISSION TX
78573-9033
US

V. Phone/Fax

Practice location:
  • Phone: 956-694-1565
  • Fax:
Mailing address:
  • Phone: 956-598-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: