Healthcare Provider Details

I. General information

NPI: 1558507624
Provider Name (Legal Business Name): JOHN A ESCANDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 N BROADWAY #201
LOS ANGELES CA
90031-2359
US

IV. Provider business mailing address

833 WINTHROP DRIVE.
LOS ANGELES CA
90032
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-2000
  • Fax:
Mailing address:
  • Phone: 626-417-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: