Provider Demographics
NPI:1053918011
Name:ESCUDERO, CARLO RAPHAEL FULGENCIO (PA-C)
Entity type:Individual
Prefix:
First Name:CARLO RAPHAEL
Middle Name:FULGENCIO
Last Name:ESCUDERO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5575 RUFFIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5575 RUFFIN RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1361
Practice Address - Country:US
Practice Address - Phone:858-277-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2021-12-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant