Healthcare Provider Details

I. General information

NPI: 1184504136
Provider Name (Legal Business Name): IVONNE ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 COLUMBIA AVE STE 200
LOS ANGELES CA
90017-1209
US

IV. Provider business mailing address

11100 ARTESIA BLVD STE A
CERRITOS CA
90703-2547
US

V. Phone/Fax

Practice location:
  • Phone: 213-249-9388
  • Fax: 213-389-7993
Mailing address:
  • Phone: 562-865-1733
  • 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: