Healthcare Provider Details

I. General information

NPI: 1194382101
Provider Name (Legal Business Name): MR. ALLAN ESCAMILLA LEBRILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W AVENUE J
LANCASTER CA
93534-2814
US

IV. Provider business mailing address

6135 W AVENUE J13
LANCASTER CA
93536-1767
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-5000
  • Fax:
Mailing address:
  • Phone: 661-998-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number645756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: