Healthcare Provider Details

I. General information

NPI: 1366274110
Provider Name (Legal Business Name): DANIEL ESCAMILLA CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 W COAST HWY # 8
NEWPORT BEACH CA
92663-4777
US

IV. Provider business mailing address

1908 VALENCIA ST
SANTA ANA CA
92706-2935
US

V. Phone/Fax

Practice location:
  • Phone: 949-881-3416
  • Fax:
Mailing address:
  • Phone: 714-230-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: