Provider Demographics
NPI:1669834792
Name:ESCOBAR, JOSEPHO (RN)
Entity Type:Individual
Prefix:
First Name:JOSEPHO
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 SULLIVAN AVE
Mailing Address - Street 2:#353
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1967
Mailing Address - Country:US
Mailing Address - Phone:650-580-2589
Mailing Address - Fax:
Practice Address - Street 1:1618 SULLIVAN AVE
Practice Address - Street 2:#353
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1967
Practice Address - Country:US
Practice Address - Phone:650-580-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA721145163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health