Healthcare Provider Details

I. General information

NPI: 1376159061
Provider Name (Legal Business Name): VICTORIA N ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E RAMSEY RD
SAN ANTONIO TX
78216-4607
US

IV. Provider business mailing address

8319 SLIPPERY ROCK
SAN ANTONIO TX
78251-2355
US

V. Phone/Fax

Practice location:
  • Phone: 210-490-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3414
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: