Healthcare Provider Details

I. General information

NPI: 1639054984
Provider Name (Legal Business Name): MARIELA TERESA ESCOBAR MENJIVAR MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41990 COOK ST STE G602
PALM DESERT CA
92211-6103
US

IV. Provider business mailing address

13440 VENTURA BLVD STE 200
SHERMAN OAKS CA
91423-6158
US

V. Phone/Fax

Practice location:
  • Phone: 760-610-6115
  • Fax:
Mailing address:
  • Phone: 760-541-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: