Provider Demographics
NPI:1366993057
Name:KENDALL NICOLE ESCOBAR
Entity type:Organization
Organization Name:KENDALL NICOLE ESCOBAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:210-997-2491
Mailing Address - Street 1:170 TERRY LN
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-3829
Mailing Address - Country:US
Mailing Address - Phone:210-997-2491
Mailing Address - Fax:830-772-5611
Practice Address - Street 1:170 TERRY LN
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-3829
Practice Address - Country:US
Practice Address - Phone:210-997-2491
Practice Address - Fax:830-772-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137889246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty