Healthcare Provider Details

I. General information

NPI: 1295626109
Provider Name (Legal Business Name): ELIZABETH LOPEZ ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

IV. Provider business mailing address

5734 FOSTORIA ST UNIT C
BELL GARDENS CA
90201-7183
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-2931
  • Fax:
Mailing address:
  • Phone: 323-425-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: