Provider Demographics
NPI:1407414741
Name:ESCOBAR, ANDREINA MARITZA (SA-C)
Entity Type:Individual
Prefix:
First Name:ANDREINA
Middle Name:MARITZA
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 DAIRY ASHFORD RD APT 116
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-3902
Mailing Address - Country:US
Mailing Address - Phone:832-630-1620
Mailing Address - Fax:
Practice Address - Street 1:611 DAIRY ASHFORD RD APT 116
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-3902
Practice Address - Country:US
Practice Address - Phone:832-630-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19-231246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant