Healthcare Provider Details

I. General information

NPI: 1194438614
Provider Name (Legal Business Name): ANGELICA TAYLOR ESCALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12399 LEWIS ST
GARDEN GROVE CA
92840-4682
US

IV. Provider business mailing address

11839 ASHWORTH ST
ARTESIA CA
90701-4110
US

V. Phone/Fax

Practice location:
  • Phone: 714-750-0575
  • Fax:
Mailing address:
  • Phone: 424-376-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: