Provider Demographics
NPI:1053060681
Name:ESCOBEDO, DIEGO MIGUEL (ACSM-CEP)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:MIGUEL
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:ACSM-CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-7659
Mailing Address - Country:US
Mailing Address - Phone:830-765-7086
Mailing Address - Fax:
Practice Address - Street 1:106 ROSE AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-7659
Practice Address - Country:US
Practice Address - Phone:830-765-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068693224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist