Provider Demographics
NPI:1154086932
Name:ESCOBEDO, BRIANNA RENEE
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:RENEE
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 LOTTSFORD RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5346
Mailing Address - Country:US
Mailing Address - Phone:240-427-3554
Mailing Address - Fax:240-419-2556
Practice Address - Street 1:9475 LOTTSFORD RD STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5346
Practice Address - Country:US
Practice Address - Phone:240-427-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR241615163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health