Healthcare Provider Details

I. General information

NPI: 1609409812
Provider Name (Legal Business Name): MARY EVE ADELINE TORRES ESCOTO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2020
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 BALBOA BLVD STE 330
GRANADA HILLS CA
91344-6358
US

IV. Provider business mailing address

8309 NORWOOD DR
MILLERSVILLE MD
21108-1511
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-7200
  • Fax:
Mailing address:
  • Phone: 267-887-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: