Healthcare Provider Details

I. General information

NPI: 1922308881
Provider Name (Legal Business Name): MR. JOSEPH ESCAMILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S SAN PEDRO ST
LOS ANGELES CA
90013-2182
US

IV. Provider business mailing address

420 S SAN PEDRO ST
LOS ANGELES CA
90013-2182
US

V. Phone/Fax

Practice location:
  • Phone: 213-620-5712
  • Fax: 213-621-4155
Mailing address:
  • Phone: 213-620-5712
  • Fax: 213-621-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: