Provider Demographics
NPI:1962202002
Name:ESCOBEDO, SANDRA (RD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15038 LE GAYE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-5141
Mailing Address - Country:US
Mailing Address - Phone:714-232-6855
Mailing Address - Fax:
Practice Address - Street 1:15038 LE GAYE ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-5141
Practice Address - Country:US
Practice Address - Phone:714-232-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered