Provider Demographics
NPI:1952555732
Name:ESCOBEDO, TINA J (NP)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:J
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8263 GROVE AVE.
Mailing Address - Street 2:100
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3107
Mailing Address - Country:US
Mailing Address - Phone:909-982-7741
Mailing Address - Fax:
Practice Address - Street 1:8263 GROVE AVE.
Practice Address - Street 2:100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3107
Practice Address - Country:US
Practice Address - Phone:909-982-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18618363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily