Healthcare Provider Details

I. General information

NPI: 1497583181
Provider Name (Legal Business Name): CYNTHIA A ESCARCEGA SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 360
GARDENA CA
90248-4338
US

IV. Provider business mailing address

1882 MOLINO AVE APT E
SIGNAL HILL CA
90755-1133
US

V. Phone/Fax

Practice location:
  • Phone: 310-819-8184
  • Fax:
Mailing address:
  • Phone: 562-375-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number4257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: