Provider Demographics
NPI:1619298627
Name:ESCOBAR, DESIRAE M
Entity Type:Individual
Prefix:DR
First Name:DESIRAE
Middle Name:M
Last Name:ESCOBAR
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 1:9005 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1563
Mailing Address - Country:US
Mailing Address - Phone:361-574-1105
Mailing Address - Fax:361-574-1024
Practice Address - Street 1:9005 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1563
Practice Address - Country:US
Practice Address - Phone:361-574-1105
Practice Address - Fax:361-574-1024
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist