Healthcare Provider Details

I. General information

NPI: 1447866173
Provider Name (Legal Business Name): DIANA ESCOBAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/19/2020
Certification Date: 09/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2414
US

IV. Provider business mailing address

1538 FAIRDALE AVE UNIT A
DUARTE CA
91010-2856
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-5000
  • Fax:
Mailing address:
  • Phone: 626-485-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: