Healthcare Provider Details

I. General information

NPI: 1982529483
Provider Name (Legal Business Name): BENJAMIN ESCOBEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 LAS PALMAS AVE
SACRAMENTO CA
95815-1607
US

IV. Provider business mailing address

4340 23RD ST
SACRAMENTO CA
95822-1516
US

V. Phone/Fax

Practice location:
  • Phone: 916-566-3480
  • Fax:
Mailing address:
  • Phone: 916-566-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number260176549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: