Healthcare Provider Details

I. General information

NPI: 1538897525
Provider Name (Legal Business Name): JENNY MARICELA ESCALANTE I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # MS 53
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

10527 RESEDA BLVD
PORTER RANCH CA
91326-3128
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-3565
  • Fax:
Mailing address:
  • Phone: 818-581-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: