Healthcare Provider Details

I. General information

NPI: 1225573942
Provider Name (Legal Business Name): EDWARD D ESCOBAR BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 09/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 INLAND EMPIRE BLVD STE 106
ONTARIO CA
91764-6582
US

IV. Provider business mailing address

1274 CENTER COURT DR STE 211
COVINA CA
91724-3668
US

V. Phone/Fax

Practice location:
  • Phone: 909-303-3595
  • Fax: 909-303-3594
Mailing address:
  • Phone: 626-339-4999
  • Fax: 626-587-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-37492
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: