Healthcare Provider Details

I. General information

NPI: 1881869741
Provider Name (Legal Business Name): MARIA ESTELA ESCALONA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 S FAIRMONT AVE STE 230
LODI CA
95240-5142
US

IV. Provider business mailing address

PO BOX 1090
LODI CA
95241-1090
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-3343
  • Fax: 209-334-1430
Mailing address:
  • Phone: 209-334-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036.119748
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA100986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: