Provider Demographics
NPI:1093095267
Name:ESCOBEDO, MARIA R (RPHT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:R
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 WILD CINNAMON DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1428
Mailing Address - Country:US
Mailing Address - Phone:321-259-3400
Mailing Address - Fax:321-253-3119
Practice Address - Street 1:7025 N WICKHAM RD
Practice Address - Street 2:SUITE 112
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7534
Practice Address - Country:US
Practice Address - Phone:321-259-3400
Practice Address - Fax:321-253-3119
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT29746183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRPT29746OtherSTATE OF FLORIDA