Healthcare Provider Details

I. General information

NPI: 1558934232
Provider Name (Legal Business Name): CORINNE MARIE ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 N GAREY AVE
POMONA CA
91767-2722
US

IV. Provider business mailing address

PO BOX 611
LAKE ARROWHEAD CA
92352-0611
US

V. Phone/Fax

Practice location:
  • Phone: 613-162-3909
  • Fax:
Mailing address:
  • Phone: 909-623-6131
  • Fax: 909-944-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: