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General NPI Number Information
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NPI Number | 1386931277
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Entity Type | Organization
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Legal Business Name | DR. DECIO M. DE ESCOBAR
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 171 GRANDVIEW AVE SUITE 101
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City | WATERBURY
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State | CT
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Zip | 06708-2517
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Country | US
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Telephone | 203-757-9336
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Fax | 203-757-9611
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Provider Business Mailing Address
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Address Line | 171 GRANDVIEW AVE SUITE 101
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City | WATERBURY
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State | CT
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Zip | 06708-2517
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Country | US
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Telephone | 203-757-9336
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Fax | 203-757-9611
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | DANELLE CONTOIS
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Credential | CPC
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Telephone | 203-757-9336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 000352
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1139
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number | 12669
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License Number State | CT
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