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Ronald J Escudero
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NPI Number Detailed Information
Provider Information:
| Name: | Ronald J Escudero |
| Gender: | M |
| Provider License Number If Given: | 91-196 |
NPI Information:
| NPI: | 1851390397 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 7/18/2005 |
| Last Update Date: | 7/8/2007 |
Provider Business Mailing Address:
| Address: | 4100 WOLCOTT AVE NE SUITE A Albuquerque, NM 87109 |
| Phone Number: | 5058555500 |
| Fax Number: | 5058555501 |
Provider Business Practice Location Address:
| Address: | 4100 WOLCOTT AVE NE SUITE A Albuquerque, NM 87109 |
| Phone Number: | 5058555500 |
| Fax Number: | 5058555501 |
Provider Taxonomy:
| Primary: | 174400000X |
| Secondary (if any): | |
| State: | NM |
