Healthcare Provider Details

I. General information

NPI: 1851571947
Provider Name (Legal Business Name): LEYNZDIANA ESCOBAR C.A.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEYNZDIANA FELIX C.A.S.

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20710 LEAPWOOD AVE
CARSON CA
90746-3642
US

IV. Provider business mailing address

20710 LEAPWOOD AVE
CARSON CA
90746-3642
US

V. Phone/Fax

Practice location:
  • Phone: 310-324-0447
  • Fax: 310-324-0147
Mailing address:
  • Phone: 310-324-0447
  • Fax: 310-324-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: