Healthcare Provider Details

I. General information

NPI: 1558290338
Provider Name (Legal Business Name): MIRNA ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N ARDMORE AVE APT 212
LOS ANGELES CA
90004-2023
US

IV. Provider business mailing address

645 N ARDMORE AVE APT 212
LOS ANGELES CA
90004-2023
US

V. Phone/Fax

Practice location:
  • Phone: 213-575-0020
  • Fax:
Mailing address:
  • Phone: 213-575-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number65689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: