Provider Demographics
NPI:1720323363
Name:ESCOBAR, JARED A (RRT,BS)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:A
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:RRT,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11403 S SKYLUX AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5046
Mailing Address - Country:US
Mailing Address - Phone:801-949-6492
Mailing Address - Fax:
Practice Address - Street 1:VETERANS HOSPITAL
Practice Address - Street 2:500 FOOTHIL DR
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-949-6492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5843733-5701227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered