Healthcare Provider Details

I. General information

NPI: 1992131361
Provider Name (Legal Business Name): MISS SHIRLEY ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 INDUSTRIAL RD STE B
SAN CARLOS CA
94070-4152
US

IV. Provider business mailing address

957 INDUSTRIAL RD STE B
SAN CARLOS CA
94070-4152
US

V. Phone/Fax

Practice location:
  • Phone: 415-713-3579
  • Fax:
Mailing address:
  • Phone: 415-713-3579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number61855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: