Healthcare Provider Details

I. General information

NPI: 1841074226
Provider Name (Legal Business Name): LIZETH ESCUDERO LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12440 FIRESTONE BLVD
NORWALK CA
90650-4328
US

IV. Provider business mailing address

12440 FIRESTONE BLVD
NORWALK CA
90650-4328
US

V. Phone/Fax

Practice location:
  • Phone: 562-864-3722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: