Healthcare Provider Details

I. General information

NPI: 1790359065
Provider Name (Legal Business Name): KIMBERLY ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 SARATOGA AVE
SAN JOSE CA
95129-4934
US

IV. Provider business mailing address

1479 SARATOGA AVE
SAN JOSE CA
95129-4934
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax: 818-241-6853
Mailing address:
  • Phone: 818-241-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: