Healthcare Provider Details

I. General information

NPI: 1821620725
Provider Name (Legal Business Name): VANESSA ESCOBAR ESCOBAR FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 02/08/2020
Certification Date: 02/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 ARCHIBALD AVE STE 110
RANCHO CUCAMONGA CA
91730-3670
US

IV. Provider business mailing address

1172 E ELMA ST APT C
ONTARIO CA
91764-6722
US

V. Phone/Fax

Practice location:
  • Phone: 909-510-7901
  • Fax:
Mailing address:
  • Phone: 909-510-7901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: