Provider Demographics
NPI:1487829131
Name:ESCOBEDO, GABRIEL RODARTE
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:RODARTE
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MILES LN
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3127
Mailing Address - Country:US
Mailing Address - Phone:831-761-5422
Mailing Address - Fax:
Practice Address - Street 1:161 MILES LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3127
Practice Address - Country:US
Practice Address - Phone:831-761-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN9016663OtherDRIVERS LIC.
CAN9016663OtherDRIVERS LIC.