Provider Demographics
NPI:1245311554
Name:ESCOBER, WILFREDO T (MD)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:T
Last Name:ESCOBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17400 IRVINE BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3030
Mailing Address - Country:US
Mailing Address - Phone:714-838-4400
Mailing Address - Fax:174-505-4345
Practice Address - Street 1:17400 IRVINE BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3030
Practice Address - Country:US
Practice Address - Phone:714-838-4400
Practice Address - Fax:174-505-4345
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC64183Medicare UPIN
CAC430260Medicare ID - Type Unspecified