MEDICARE: LETICIA ESCOBEDO NURSE PRACTITIONER

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
1	363LW0102X	Women's Health Nurse Practitioner	525273	TX

General Provider Information

NPI Number	:	1629292966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETICIA ESCOBEDO NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1304 S 25TH AVE
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78542-7205
Country	:	US
Telephone Number	:	956-383-6221
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 S 25TH AVE
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78542-7205
Country	:	US
Telephone Number	:	956-383-6221
Fax Number	:	956-383-8864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	12/08/2011

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