Provider Demographics
NPI:1376344119
Name:ESCOBAR, NIXON (MHC-I)
Entity type:Individual
Prefix:MR
First Name:NIXON
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:MHC-I
Other - Prefix:MR
Other - First Name:NIXON
Other - Middle Name:ALEXNADER
Other - Last Name:JARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC-I
Mailing Address - Street 1:905 43RD ST APT A5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1722
Mailing Address - Country:US
Mailing Address - Phone:646-884-1363
Mailing Address - Fax:
Practice Address - Street 1:307 W 38TH ST FL 16
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9514
Practice Address - Country:US
Practice Address - Phone:332-249-1911
Practice Address - Fax:332-265-0277
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program