Healthcare Provider Details

I. General information

NPI: 1639701121
Provider Name (Legal Business Name): INGRID ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 E COLORADO BLVD # 2101
PASADENA CA
91105-1986
US

IV. Provider business mailing address

6046 ELEANOR AVE APT 206
LOS ANGELES CA
90038-2855
US

V. Phone/Fax

Practice location:
  • Phone: 323-963-4625
  • Fax:
Mailing address:
  • Phone: 323-821-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12147043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: