Healthcare Provider Details

I. General information

NPI: 1548080807
Provider Name (Legal Business Name): REBECCA ESCANDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 10TH AVE
LOS ANGELES CA
90018-4114
US

IV. Provider business mailing address

3609 10TH AVE
LOS ANGELES CA
90018-4114
US

V. Phone/Fax

Practice location:
  • Phone: 424-429-2845
  • Fax:
Mailing address:
  • Phone: 424-429-2845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: