Healthcare Provider Details

I. General information

NPI: 1306224803
Provider Name (Legal Business Name): FABIOLA VANESSA ESCALANTE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11470 DELANO ST
NORTH HOLLYWOOD CA
91606-4130
US

IV. Provider business mailing address

11470 DELANO ST
NORTH HOLLYWOOD CA
91606-4130
US

V. Phone/Fax

Practice location:
  • Phone: 323-445-8785
  • Fax:
Mailing address:
  • Phone: 323-445-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number72018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: