Provider Demographics
NPI:1144844218
Name:ESCOTO, REBECCA E (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:ESCOTO
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3064 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4843
Mailing Address - Country:US
Mailing Address - Phone:425-890-6972
Mailing Address - Fax:
Practice Address - Street 1:570 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6512
Practice Address - Country:US
Practice Address - Phone:212-562-3346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58140363A00000X
NY027699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant