Provider Demographics
NPI:1174766976
Name:ESCUDERO, JOSEPH DUC (CPT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DUC
Last Name:ESCUDERO
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 FIESTA PARK NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5275
Mailing Address - Country:US
Mailing Address - Phone:505-974-9177
Mailing Address - Fax:
Practice Address - Street 1:11101 FIESTA PARK NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5275
Practice Address - Country:US
Practice Address - Phone:505-974-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20-0034R06246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy