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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

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