Healthcare Provider Details

I. General information

NPI: 1467588350
Provider Name (Legal Business Name): ISABEL C ESCALANTE DE LEAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST
FRESNO CA
93721-1324
US

IV. Provider business mailing address

5358 W FALLBROOK AVE
FRESNO CA
93722-2364
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-3961
  • Fax:
Mailing address:
  • Phone: 559-271-2732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12606
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: