Provider Demographics
NPI:1699072769
Name:ESCOBEDO, LENA NICOLE (CSA)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:NICOLE
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1264
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78630-1264
Mailing Address - Country:US
Mailing Address - Phone:512-981-7090
Mailing Address - Fax:
Practice Address - Street 1:13656 TEAGUE LN
Practice Address - Street 2:#7
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5207
Practice Address - Country:US
Practice Address - Phone:512-981-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCERT NO 3649246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3649OtherCERTIFICATION