Healthcare Provider Details

I. General information

NPI: 1124755277
Provider Name (Legal Business Name): ANGEL DE LUNA ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 EUCLID AVE # 386
SAN DIEGO CA
92114-3610
US

IV. Provider business mailing address

1053 LINCOLN AVE
SAN DIEGO CA
92103-2319
US

V. Phone/Fax

Practice location:
  • Phone: 619-527-7390
  • Fax:
Mailing address:
  • Phone: 619-870-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: