Provider Demographics
NPI:1306347687
Name:ESCOBEDO, JOSIE MALINDA
Entity type:Individual
Prefix:MS
First Name:JOSIE
Middle Name:MALINDA
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:MALINDA
Other - Last Name:ESCOBEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JOSEPHINE
Mailing Address - Street 1:207 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CISCO
Mailing Address - State:TX
Mailing Address - Zip Code:76437-4304
Mailing Address - Country:US
Mailing Address - Phone:325-669-8285
Mailing Address - Fax:
Practice Address - Street 1:207 W 17TH ST
Practice Address - Street 2:
Practice Address - City:CISCO
Practice Address - State:TX
Practice Address - Zip Code:76437-4304
Practice Address - Country:US
Practice Address - Phone:325-669-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206698164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse