Provider Demographics
NPI:1962969212
Name:DANELA S ESCUETA MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DANELA S ESCUETA MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ESCUETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-344-5565
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:565 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2423
Practice Address - Country:US
Practice Address - Phone:760-344-5565
Practice Address - Fax:760-344-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty