Healthcare Provider Details

I. General information

NPI: 1760506729
Provider Name (Legal Business Name): CARINA ESCUDERO TESTA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARINA MICHELE ESCUDERO MPT

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 AVIATION BLVD
HERMOSA BEACH CA
90254-4023
US

IV. Provider business mailing address

1035 AVIATION BLVD
HERMOSA BEACH CA
90254-4023
US

V. Phone/Fax

Practice location:
  • Phone: 310-937-2323
  • Fax: 310-937-3399
Mailing address:
  • Phone: 310-937-2323
  • Fax: 310-937-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT21285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: