Healthcare Provider Details

I. General information

NPI: 1336010966
Provider Name (Legal Business Name): JULIO ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 KEITH ST
LINCOLN HEIGHTS CA
90031-3128
US

IV. Provider business mailing address

734 VALENCIA ST APT 308
LOS ANGELES CA
90017-4339
US

V. Phone/Fax

Practice location:
  • Phone: 213-721-0010
  • Fax:
Mailing address:
  • Phone: 213-887-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: