Provider Demographics
NPI:1619574746
Name:ESCOBEDO, CALLIE R (RN)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:R
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-1309
Mailing Address - Country:US
Mailing Address - Phone:619-203-2470
Mailing Address - Fax:
Practice Address - Street 1:3609 OCEAN RANCH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-8601
Practice Address - Country:US
Practice Address - Phone:619-203-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA795115163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse