Provider Demographics
NPI:1659327740
Name:ESCOBEDO, JOSEPHAT (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPHAT
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4430 E 14TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3364
Practice Address - Country:US
Practice Address - Phone:956-986-0707
Practice Address - Fax:956-986-0707
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
TX29671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016917901Medicaid
TX091592801OtherCCP