Healthcare Provider Details

I. General information

NPI: 1528316874
Provider Name (Legal Business Name): LIDIA MANETTA ESCOBAR LCSW 23163, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15683 PONDEROSA LN
CHINO HILLS CA
91709-3342
US

IV. Provider business mailing address

15683 PONDEROSA LN
CHINO HILLS CA
91709-3342
US

V. Phone/Fax

Practice location:
  • Phone: 909-957-8277
  • Fax: 909-248-0527
Mailing address:
  • Phone: 909-957-8277
  • Fax: 909-248-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: