Healthcare Provider Details

I. General information

NPI: 1568076867
Provider Name (Legal Business Name): LYNETTE EDITH ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 EXECUTIVE CENTER BLVD STE 148
EL PASO TX
79902-1096
US

IV. Provider business mailing address

444 EXECUTIVE CENTER BLVD STE 148
EL PASO TX
79902-1096
US

V. Phone/Fax

Practice location:
  • Phone: 915-213-1289
  • Fax:
Mailing address:
  • Phone: 915-213-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number990043
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: