Healthcare Provider Details

I. General information

NPI: 1063376416
Provider Name (Legal Business Name): MARIAH ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N A ST
LOMPOC CA
93436-3516
US

IV. Provider business mailing address

297 BURTON MESA BLVD APT B
LOMPOC CA
93436-1488
US

V. Phone/Fax

Practice location:
  • Phone: 805-742-3300
  • Fax:
Mailing address:
  • Phone: 805-742-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberBA483450C1
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: