Healthcare Provider Details

I. General information

NPI: 1356846620
Provider Name (Legal Business Name): JOSEPH ESCOBAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE STE 610
LOS ANGELES CA
90027-6088
US

IV. Provider business mailing address

1300 N VERMONT AVE STE 610
LOS ANGELES CA
90027-6088
US

V. Phone/Fax

Practice location:
  • Phone: 818-268-5536
  • Fax:
Mailing address:
  • Phone: 818-268-5536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA173567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: