Healthcare Provider Details

I. General information

NPI: 1629327697
Provider Name (Legal Business Name): LOURDES ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PINE AVE
LONG BEACH CA
90813
US

IV. Provider business mailing address

1301 PINE AVE
LONG BEACH CA
90813-3124
US

V. Phone/Fax

Practice location:
  • Phone: 562-216-2305
  • Fax:
Mailing address:
  • Phone: 562-216-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: