Healthcare Provider Details

I. General information

NPI: 1891987566
Provider Name (Legal Business Name): ARACELY ESCOBEDO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 FREDRICKSBURG RD #107
SAN ANTONIO TX
78201-2031
US

IV. Provider business mailing address

4400 FREDERICKSBURG RD STE 107
SAN ANTONIO TX
78201-1969
US

V. Phone/Fax

Practice location:
  • Phone: 210-737-1926
  • Fax: 210-737-2621
Mailing address:
  • Phone: 210-737-1926
  • Fax: 210-737-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7086 TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: