Healthcare Provider Details

I. General information

NPI: 1679228936
Provider Name (Legal Business Name): LUIS ESCALANTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6043 HOLLYWOOD BLVD
LOS ANGELES CA
90028-5411
US

IV. Provider business mailing address

8405 BEVERLY BLVD
LOS ANGELES CA
90048-3401
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-1990
  • Fax:
Mailing address:
  • Phone: 323-653-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1679228936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: