Healthcare Provider Details

I. General information

NPI: 1700760774
Provider Name (Legal Business Name): ESCOBAR WELLNESS & PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12309 DESERT PATH CT
EL PASO TX
79938-2419
US

IV. Provider business mailing address

4717 HONDO PASS DR
EL PASO TX
79904-1474
US

V. Phone/Fax

Practice location:
  • Phone: 915-975-7028
  • Fax: 915-292-7561
Mailing address:
  • Phone: 915-975-7028
  • Fax: 915-292-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: FABIAN ESCOBAR
Title or Position: PMHNP
Credential: PMHNP
Phone: 915-975-7028