Healthcare Provider Details

I. General information

NPI: 1851415996
Provider Name (Legal Business Name): MIRIAM ESCOVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11927 ELLIOTT AVE
EL MONTE CA
91732-3740
US

IV. Provider business mailing address

1223 9TH AVE
HACIENDA HEIGHTS CA
91745-2027
US

V. Phone/Fax

Practice location:
  • Phone: 626-350-5304
  • Fax: 626-350-0756
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: