Kim Escudero, M.D.
Individual provider Active NPI Pediatrics Physician · Mammoth Lakes, CA
NPI 1063568293 · NPPES record last updated Mar 12, 2013
Key facts
- NPI
- 1063568293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- A61421 (CA)
- Practice address
- 85 Sierra Park Rd
Mammoth Lakes, CA 93546-0660 - Phone
- (760) 924-4000
- Fax
- (760) 924-4091
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A61421 | CA | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A61421 | CA | Yes |
Addresses
Primary practice location
85 Sierra Park Rd
Mammoth Lakes, CA 93546-0660
Mailing address
PO Box 660
85 Sierra Park Rd
Mammoth Lakes, CA 93546-0660
Phone (760) 924-4000
Other providers in Mammoth Lakes, CA
- Kristen Anne Dorough
- Dr Maria M. King Inc
- Gabrielle Duhl
- Iris Duran
- Jacob Andrew Eide
- Sierra Farquhar
- Amanda J Feinberg
- France Jacqueline Fischer
- Sofia Carolina Flores
- Christy Allison Forkenbrock
All providers in Mammoth Lakes, CA · Pediatrics Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.