Healthcare Provider Details

I. General information

NPI: 1255021911
Provider Name (Legal Business Name): MIRIAM ELIZABETH ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 W 6TH ST
LOS ANGELES CA
90017-1004
US

IV. Provider business mailing address

4851 EAGLE ROCK BLVD
LOS ANGELES CA
90041-2631
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-2458
  • Fax: 213-413-9621
Mailing address:
  • Phone: 323-535-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH70088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: