Healthcare Provider Details

I. General information

NPI: 1477670750
Provider Name (Legal Business Name): OSCAR A ESCOBAR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 S CENTRAL AVE
LOS ANGELES CA
90001-1150
US

IV. Provider business mailing address

3702 W HEFFRON DR
BURBANK CA
91505-3420
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-3280
  • Fax:
Mailing address:
  • Phone: 818-845-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: