Healthcare Provider Details

I. General information

NPI: 1942448923
Provider Name (Legal Business Name): ALBERT QUIRAP ESCOBAR PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N 4TH ST STE 216
MONTEBELLO CA
90640-4309
US

IV. Provider business mailing address

1538 W DELVALE ST
WEST COVINA CA
91790-4545
US

V. Phone/Fax

Practice location:
  • Phone: 323-530-0433
  • Fax: 323-530-0434
Mailing address:
  • Phone: 323-717-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT19096
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: