Healthcare Provider Details

I. General information

NPI: 1295859247
Provider Name (Legal Business Name): ADRIANA GEMINA ESCAMILLA MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21545 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-2947
US

IV. Provider business mailing address

25145 CENTRE POIONTE PRWY
SANTA CLARITA CA
91350
US

V. Phone/Fax

Practice location:
  • Phone: 818-825-1278
  • Fax:
Mailing address:
  • Phone: 818-825-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: