Healthcare Provider Details

I. General information

NPI: 1649565193
Provider Name (Legal Business Name): MARTHA ESCUDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 E WASHINGTON BLVD SUITE 900
COMMERCE CA
90040-2449
US

IV. Provider business mailing address

8652 CHESTNUT AVE APT. B
SOUTH GATE CA
90280-2772
US

V. Phone/Fax

Practice location:
  • Phone: 323-346-0960
  • Fax:
Mailing address:
  • Phone: 909-461-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: