Healthcare Provider Details

I. General information

NPI: 1134713092
Provider Name (Legal Business Name): MR. MANUEL ALEXANDER ESCOBAR SOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CORPORATE CENTER DR STE 210
POMONA CA
91768-2627
US

IV. Provider business mailing address

801 CORPORATE CENTER DR STE 210
POMONA CA
91768-2627
US

V. Phone/Fax

Practice location:
  • Phone: 909-634-3974
  • Fax:
Mailing address:
  • Phone: 909-634-3974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: