Basic Information
Provider Information | |||||||||
NPI: | 1962917997 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ESCOBAR | ||||||||
FirstName: | ANGIOLLET | ||||||||
MiddleName: | SOLIS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2534 BOCA CHICA BLVD | ||||||||
Address2: |   | ||||||||
City: | BROWNSVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 785213496 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9564955378 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2534 BOCA CHICA BLVD STE 7 | ||||||||
Address2: |   | ||||||||
City: | BROWNSVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 785213496 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9565462000 | ||||||||
FaxNumber: | 9565462001 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/13/2017 | ||||||||
LastUpdateDate: | 07/29/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/29/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP135547 | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.