Healthcare Provider Details

I. General information

NPI: 1063754349
Provider Name (Legal Business Name): LUCILITA P ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR BLDG A
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR BLDG A
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-4982
  • Fax:
Mailing address:
  • Phone: 209-525-4982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-RFHUKA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: