Healthcare Provider Details

I. General information

NPI: 1033375431
Provider Name (Legal Business Name): ELVIRA DIANE ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16480 HARBOR BLVD SUITE 103
SANTA ANA CA
92708-1361
US

IV. Provider business mailing address

10443 SLATER AVE APT 104
FOUNTAIN VALLEY CA
92708-7708
US

V. Phone/Fax

Practice location:
  • Phone: 714-418-9606
  • Fax: 714-418-1575
Mailing address:
  • Phone: 714-378-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: