Provider Demographics
NPI:1073559514
Name:ESCARA, FELY T (MD)
Entity Type:Individual
Prefix:
First Name:FELY
Middle Name:T
Last Name:ESCARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FELY
Other - Middle Name:T
Other - Last Name:ESCARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25900 N HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9392
Mailing Address - Country:US
Mailing Address - Phone:209-339-9022
Mailing Address - Fax:209-339-9033
Practice Address - Street 1:36 W YOKUTS AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5713
Practice Address - Country:US
Practice Address - Phone:209-952-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A312311Medicare ID - Type UnspecifiedMEDICARE
CAA26397Medicare UPIN