Healthcare Provider Details

I. General information

NPI: 1699542985
Provider Name (Legal Business Name): DESIREE ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 E COMMON ST
NEW BRAUNFELS TX
78130-3173
US

IV. Provider business mailing address

6714 RAINTREE PL
SAN ANTONIO TX
78233-3970
US

V. Phone/Fax

Practice location:
  • Phone: 210-996-7060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT139259
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: