Provider Demographics
NPI:1609696426
Name:SOCORRO ESCOBEDO
Entity type:Organization
Organization Name:SOCORRO ESCOBEDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOCORRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-352-0417
Mailing Address - Street 1:1309 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2516
Mailing Address - Country:US
Mailing Address - Phone:562-352-0417
Mailing Address - Fax:562-366-0560
Practice Address - Street 1:AVE 5 DE MAYO 868-C
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BC
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:562-352-0417
Practice Address - Fax:562-366-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty