NPIMap

Organization Active NPI

Portia Maristela Escobar, DMD, PDC

  • General Practice Dentistry
  • Vallejo, CA
National Provider Identifier
1699890350
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
45854 Issued in CA
Legal business name
PORTIA MARISTELA ESCOBAR, DMD, PDC
Practice address
3772 Sonoma Blvd
Vallejo, CA 94589-2202
Phone
(707) 557-6680
Fax
(707) 554-6688
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Portia Escobar, DMDNPI 1093074585
Title
President
Phone
(707) 557-6680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 45854 CA Primary

Addresses

Primary practice location

3772 Sonoma Blvd
Vallejo, CA 94589-2202

Mailing address

3772 Sonoma Blvd
Vallejo, CA 94589-2202
Phone (707) 557-6680

Other identifiers 2

IdentifierTypeStateIssuer
B45854-01OtherCAHEALTHY FAMILIES
B45854-01OtherCADENTI-CAL, MEDI-CAL

Other names 1

  • Portia Maristela Escobar, Professional Dental Corporation Other name

National Provider Directory

National Provider Directory

Locations

3772 Sonoma Blvd
Vallejo, CA 94589
Phone (707) 557-6680

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1699890350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3772 SONOMA BLVD",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892202",
            "telephone_number": "707-557-6680",
            "fax_number": "707-554-6688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3772 SONOMA BLVD",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892202",
            "telephone_number": "707-557-6680",
            "fax_number": "707-554-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTIA MARISTELA ESCOBAR, DMD, PDC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "ESCOBAR",
        "authorized_official_first_name": "PORTIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-557-6680",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "45854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILIES",
            "identifier": "B45854-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL, MEDI-CAL",
            "identifier": "B45854-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portia Maristela Escobar, Professional Dental Corporation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vallejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.