Healthcare Provider Details

I. General information

NPI: 1033694633
Provider Name (Legal Business Name): JOSE ESCOBEDO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 N 10TH ST SUITE 205
MCALLEN TX
78504
US

IV. Provider business mailing address

515 MOORE RD
ALAMO TX
78516
US

V. Phone/Fax

Practice location:
  • Phone: 956-457-2919
  • Fax:
Mailing address:
  • Phone: 956-457-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberC46789
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: