Healthcare Provider Details

I. General information

NPI: 1366932238
Provider Name (Legal Business Name): CECILIA RAQUEL ESCOBEDO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14362 RAMONA BLVD
BALDWIN PARK CA
91706-3241
US

IV. Provider business mailing address

4003 N HARTLEY AVE
COVINA CA
91722-3914
US

V. Phone/Fax

Practice location:
  • Phone: 626-315-6270
  • Fax:
Mailing address:
  • Phone: 626-315-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95008219
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP95008219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: