Provider Demographics
NPI:1285961730
Name:CLINICA PODIATRICA DR ESCALONA PSC
Entity type:Organization
Organization Name:CLINICA PODIATRICA DR ESCALONA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-764-8798
Mailing Address - Street 1:B3 CALLE 1
Mailing Address - Street 2:VILLAS DE SAN FRANCISCO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6449
Mailing Address - Country:US
Mailing Address - Phone:787-764-8798
Mailing Address - Fax:787-523-0925
Practice Address - Street 1:359 CALLE SAN CLAUDIO # CUPEY
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9907
Practice Address - Country:US
Practice Address - Phone:787-764-8798
Practice Address - Fax:787-523-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR071213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU63106Medicare UPIN