Healthcare Provider Details

I. General information

NPI: 1225969611
Provider Name (Legal Business Name): EDITH ESCAMILLA VIZCARRA MS., PPS SP, PPS SC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34257 KALANCHOE RD
LAKE ELSINORE CA
92532-2996
US

IV. Provider business mailing address

34257 KALANCHOE RD
LAKE ELSINORE CA
92532-2996
US

V. Phone/Fax

Practice location:
  • Phone: 951-244-7657
  • Fax:
Mailing address:
  • Phone: 951-244-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220209170
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220209170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: