Healthcare Provider Details

I. General information

NPI: 1790150035
Provider Name (Legal Business Name): KEVIN ALEXANDER ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2015
Last Update Date: 12/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16500 VENTURA BLVD SUITE 414
ENCINO CA
91436-2011
US

IV. Provider business mailing address

15526 CHASE ST APT 36
NORTH HILLS CA
91343-6566
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-1003
  • Fax:
Mailing address:
  • Phone: 818-836-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: