Healthcare Provider Details

I. General information

NPI: 1962202002
Provider Name (Legal Business Name): SANDRA ESCOBEDO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15038 LE GAYE ST
LAKE ELSINORE CA
92530-5141
US

IV. Provider business mailing address

15038 LE GAYE ST
LAKE ELSINORE CA
92530-5141
US

V. Phone/Fax

Practice location:
  • Phone: 714-232-6855
  • Fax:
Mailing address:
  • Phone: 714-232-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: