Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 000352 | CT |
Y | 208D00000X | General Practice Physician | 06917 | AZ |
NPI | 1053331462 |
---|---|
Provider Name | Dr. Marcos Malli De Escobar |
First Address | Scottsdale, AZ 85254-5216 |
Second Address | Scottsdale, AZ 85254-5216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 18/11/2015 |