Healthcare Provider Details

I. General information

NPI: 1174082663
Provider Name (Legal Business Name): RUBEN ERNESTO ESCAMILLA M.A. CLINICAL PSYC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S 2ND AVE
COVINA CA
91723-3012
US

IV. Provider business mailing address

457 KNOLLCREST DR STE 120
REDDING CA
96002-0121
US

V. Phone/Fax

Practice location:
  • Phone: 626-974-8123
  • Fax: 626-974-8198
Mailing address:
  • Phone: 707-703-5600
  • Fax: 530-232-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: