Healthcare Provider Details

I. General information

NPI: 1376119230
Provider Name (Legal Business Name): JASMINE NOEL ESCOBEDO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

2121 W TEMPLE ST
LOS ANGELES CA
90026-4915
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8521
  • Fax:
Mailing address:
  • Phone: 213-385-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number111161
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: