Healthcare Provider Details

I. General information

NPI: 1306522073
Provider Name (Legal Business Name): EDWIN ESCARO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 GRACIE ALLEN DR
LOS ANGELES CA
90048-3811
US

IV. Provider business mailing address

15133 FLORWOOD AVE
LAWNDALE CA
90260-2324
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95025609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: