Healthcare Provider Details

I. General information

NPI: 1669360491
Provider Name (Legal Business Name): JAVIER ESCOBEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 RESEDA BLVD STE 210
NORTHRIDGE CA
91324-6143
US

IV. Provider business mailing address

6925 CANOGA AVE
CANOGA PARK CA
91303-2032
US

V. Phone/Fax

Practice location:
  • Phone: 747-262-8969
  • Fax:
Mailing address:
  • Phone: 747-262-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: