Healthcare Provider Details

I. General information

NPI: 1417778366
Provider Name (Legal Business Name): MARIA ESCORCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 WILSHIRE BLVD
LOS ANGELES CA
90010-3805
US

IV. Provider business mailing address

172 N MARIPOSA AVE APT C
LOS ANGELES CA
90004-6299
US

V. Phone/Fax

Practice location:
  • Phone: 323-836-0860
  • Fax:
Mailing address:
  • Phone: 309-657-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: