Healthcare Provider Details

I. General information

NPI: 1023905288
Provider Name (Legal Business Name): ILIANA ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 E BUSTAMANTE ST STE B
LAREDO TX
78041-5305
US

IV. Provider business mailing address

1504 CENTENO LN
RIO BRAVO TX
78046-7819
US

V. Phone/Fax

Practice location:
  • Phone: 956-568-3009
  • Fax: 956-568-3048
Mailing address:
  • Phone: 956-229-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number824299
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1196374
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: