Healthcare Provider Details

I. General information

NPI: 1750967873
Provider Name (Legal Business Name): RAUL ESCOBEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 CROSSROADS PKWY N STE 335
CITY OF INDUSTRY CA
91746-3485
US

IV. Provider business mailing address

4221 WILSHIRE BLVD STE 300A
LOS ANGELES CA
90010-3537
US

V. Phone/Fax

Practice location:
  • Phone: 562-821-1491
  • Fax: 562-502-6169
Mailing address:
  • Phone: 888-428-3223
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: