Healthcare Provider Details

I. General information

NPI: 1437669546
Provider Name (Legal Business Name): JONATHAN ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 FOLSOM BLVD STE 195
SACRAMENTO CA
95826-3231
US

IV. Provider business mailing address

10897 COLOMA RD UNIT 2
RANCHO CORDOVA CA
95670-2635
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-8120
  • Fax:
Mailing address:
  • Phone: 415-623-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: