Healthcare Provider Details

I. General information

NPI: 1619298627
Provider Name (Legal Business Name): DR. DESIRAE M ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 N NAVARRO ST
VICTORIA TX
77904-1563
US

IV. Provider business mailing address

9005 N NAVARRO ST
VICTORIA TX
77904-1563
US

V. Phone/Fax

Practice location:
  • Phone: 361-574-1105
  • Fax: 361-574-1024
Mailing address:
  • Phone: 361-574-1105
  • Fax: 361-574-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45617
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: