Provider Demographics
NPI:1679710743
Name:ESCOBEDO, JULIO CESAR (RDA)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:CESAR
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9841 MADISON AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-4341
Mailing Address - Country:US
Mailing Address - Phone:323-572-5921
Mailing Address - Fax:
Practice Address - Street 1:4149 TWEEDY BLVD STE J
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6167
Practice Address - Country:US
Practice Address - Phone:323-567-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70766126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant