Provider Demographics
NPI:1063793065
Name:ESCOBAL, FIDES P (FNP)
Entity type:Individual
Prefix:MS
First Name:FIDES
Middle Name:P
Last Name:ESCOBAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:FIDES
Other - Middle Name:P
Other - Last Name:ESCOBAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 8188
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-1388
Mailing Address - Country:US
Mailing Address - Phone:909-790-5071
Mailing Address - Fax:909-790-5774
Practice Address - Street 1:17264 FOOTHILL BLVD STE AB
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-9050
Practice Address - Country:US
Practice Address - Phone:909-428-3900
Practice Address - Fax:909-428-3903
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily