Healthcare Provider Details

I. General information

NPI: 1154010882
Provider Name (Legal Business Name): KRISTINE ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E WASHINGTON BLVD
PASADENA CA
91104-5003
US

IV. Provider business mailing address

800 S SANTA ANITA AVE
ARCADIA CA
91006-3536
US

V. Phone/Fax

Practice location:
  • Phone: 626-797-9007
  • Fax:
Mailing address:
  • Phone: 626-940-7928
  • Fax: 626-577-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: