Healthcare Provider Details

I. General information

NPI: 1609650464
Provider Name (Legal Business Name): ANGELA MARLENY ESCOBAR MONROY AMFT149440
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MAGNOLIA AVE
LOS ANGELES CA
90007-1220
US

IV. Provider business mailing address

1910 MAGNOLIA AVE
LOS ANGELES CA
90007-1220
US

V. Phone/Fax

Practice location:
  • Phone: 323-652-1609
  • Fax:
Mailing address:
  • Phone: 323-868-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT149440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: