Healthcare Provider Details

I. General information

NPI: 1245637933
Provider Name (Legal Business Name): MR. JOSE UBALDO ESCOBEDO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 E PACIFIC COAST HWY
LONG BEACH CA
90804-3279
US

IV. Provider business mailing address

741 HAMILTON ST
COSTA MESA CA
92627-2919
US

V. Phone/Fax

Practice location:
  • Phone: 562-346-1100
  • Fax:
Mailing address:
  • Phone: 949-836-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: