Healthcare Provider Details

I. General information

NPI: 1063887677
Provider Name (Legal Business Name): STEPHANIE ESCARZAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 N. ARROWHEAD AVE. SUITE 200
SAN BERNARDINO CA
92415-1855
US

IV. Provider business mailing address

820 E GILBERT ST
SAN BERNARDINO CA
92415-0928
US

V. Phone/Fax

Practice location:
  • Phone: 909-387-7200
  • Fax:
Mailing address:
  • Phone: 909-387-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: