Healthcare Provider Details

I. General information

NPI: 1972263598
Provider Name (Legal Business Name): JUSTINE ESCARCEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 FORD ST
OAKLAND CA
94601-2114
US

IV. Provider business mailing address

2828 FORD ST
OAKLAND CA
94601-2114
US

V. Phone/Fax

Practice location:
  • Phone: 510-913-4696
  • Fax:
Mailing address:
  • Phone: 510-913-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: