Provider Demographics
NPI:1871934232
Name:ESCOBEDO, EVE (LMP)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:KOLB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1102 SW BAY ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5409
Mailing Address - Country:US
Mailing Address - Phone:360-362-9404
Mailing Address - Fax:
Practice Address - Street 1:450 PORT ORCHARD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4705
Practice Address - Country:US
Practice Address - Phone:360-895-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60058291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist