Healthcare Provider Details

I. General information

NPI: 1598805103
Provider Name (Legal Business Name): SANDRA ELIZABETH ESCOBAR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 W 6TH ST
LOS ANGELES CA
90017-1828
US

IV. Provider business mailing address

3959 POPPYSEED PL
CALABASAS CA
91302-2947
US

V. Phone/Fax

Practice location:
  • Phone: 213-639-2501
  • Fax:
Mailing address:
  • Phone: 818-878-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: