Provider Demographics
NPI:1174860316
Name:ESCOBEDO, TANYA LEE (ND)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:LEE
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:LEE
Other - Last Name:POOLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 RENATO CT
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-4093
Mailing Address - Country:US
Mailing Address - Phone:650-271-9453
Mailing Address - Fax:702-819-7008
Practice Address - Street 1:61 RENATO CT
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-4093
Practice Address - Country:US
Practice Address - Phone:650-271-9453
Practice Address - Fax:702-819-7008
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-562175F00000X
CAND 562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANDF562OtherDRUG FURNISHING