Basic Information
| Provider Information | |||||||||
| NPI: | 1649256447 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESCOBAR | ||||||||
| FirstName: | BEATRIZ | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8401 DATAPOINT DR STE 600 | ||||||||
| Address2: | P. O. BOX 29407 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167700 | ||||||||
| FaxNumber: | 2106167709 | ||||||||
| Practice Location | |||||||||
| Address1: | 8401 DATAPOINT DR STE 600 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167700 | ||||||||
| FaxNumber: | 2106167709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 287510 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 287510 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1468241-04 | 05 | TX | MEDICAID | 1468241-06 | 05 | TX | MEDICAID | L1030 | 01 | TX | TEXAS MEDICAL LICENSE | OTHER | P00449061 | 01 | TX | RAILROAD MEDICARE | OTHER | 1468241-05 | 05 | TX | MEDICAID | 8J6984 | 01 | TX | MEDICARE - STRG | OTHER | P00450302 | 01 | TX | RAILROAD MEDICARE | OTHER |