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NPI Code Detail

MEDICARE: DERIK ESCOBEDO

MEDICARE: DERIK ESCOBEDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician19-107154TX

General Provider Information

NPI Number : 1225668817
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERIK ESCOBEDO
Provider Business Mailing Address
First Line : 2424 VILLAGE DR
Second Line :
City : BROWNSVILLE
State : TX
Zip : 78521-1480
Country : US
Telephone Number : 956-431-0056
Fax Number : 832-553-7287
Provider Business Practice Location Address
First Line : 2424 VILLAGE DR
Second Line :
City : BROWNSVILLE
State : TX
Zip : 78521-1480
Country : US
Telephone Number : 956-431-0056
Fax Number : 832-553-7287
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2020
Last Update Date : 01/22/2020

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Directions to “ DERIK ESCOBEDO ” Practice Location

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