Healthcare Provider Details

I. General information

NPI: 1801759105
Provider Name (Legal Business Name): MIREYA ESCUDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 N SUNRISE WAY
PALM SPRINGS CA
92262-3408
US

IV. Provider business mailing address

PO BOX 2152
CATHEDRAL CITY CA
92235-2152
US

V. Phone/Fax

Practice location:
  • Phone: 760-322-1131
  • Fax:
Mailing address:
  • Phone: 760-322-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number18573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: