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General NPI Number Information
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NPI Number | 1699890350
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Entity Type | Organization
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Legal Business Name | PORTIA MARISTELA ESCOBAR, DMD, PDC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 3772 SONOMA BLVD
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City | VALLEJO
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State | CA
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Zip | 94589-2202
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Country | US
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Telephone | 707-557-6680
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Fax | 707-554-6688
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Provider Business Mailing Address
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Address Line | 3772 SONOMA BLVD
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City | VALLEJO
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State | CA
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Zip | 94589-2202
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Country | US
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Telephone | 707-557-6680
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Fax | 707-554-6688
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PORTIA ESCOBAR
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Credential | DMD
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Telephone | 707-557-6680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 45854
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License Number State | CA
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