Healthcare Provider Details

I. General information

NPI: 1821609058
Provider Name (Legal Business Name): FERNANDO RAMON ESCOBEDO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22751 EL PRADO APT 4203
RANCHO SANTA MARGARITA CA
92688-3828
US

IV. Provider business mailing address

22751 EL PRADO APT 4203
RANCHO SANTA MARGARITA CA
92688-3828
US

V. Phone/Fax

Practice location:
  • Phone: 562-805-6890
  • Fax:
Mailing address:
  • Phone: 562-805-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: