Healthcare Provider Details

I. General information

NPI: 1992853709
Provider Name (Legal Business Name): LOUIS ESCANDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 POMONA BLVD
LOS ANGELES CA
90022-1716
US

IV. Provider business mailing address

5425 POMONA BLVD
LOS ANGELES CA
90022-1716
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-0411
  • Fax: 323-728-1535
Mailing address:
  • Phone: 323-728-0411
  • Fax: 323-728-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG34397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: