Healthcare Provider Details

I. General information

NPI: 1932097656
Provider Name (Legal Business Name): DEMETRIUS ESCLOVON JR. ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

IV. Provider business mailing address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

V. Phone/Fax

Practice location:
  • Phone: 510-866-6002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: