Healthcare Provider Details

I. General information

NPI: 1558797324
Provider Name (Legal Business Name): NORA ESCOBAR-MANDUJANO M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 NORTH 'D' STREET
SAN BERNARDINO CA
92405
US

IV. Provider business mailing address

1441 NORTH 'D' STREET
SAN BERNARDINO CA
92405
US

V. Phone/Fax

Practice location:
  • Phone: 760-449-7877
  • Fax:
Mailing address:
  • Phone: 760-449-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number61034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: