Provider Demographics
NPI:1073809893
Name:ESCOBAR, PEDRO ARCENIO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:ARCENIO
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE COVE
Mailing Address - State:CA
Mailing Address - Zip Code:93646-2505
Mailing Address - Country:US
Mailing Address - Phone:559-356-2381
Mailing Address - Fax:
Practice Address - Street 1:555 6TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE COVE
Practice Address - State:CA
Practice Address - Zip Code:93646-2136
Practice Address - Country:US
Practice Address - Phone:559-626-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21639363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical