Healthcare Provider Details

I. General information

NPI: 1790448561
Provider Name (Legal Business Name): MRS. ALMA IRMA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 02/13/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CARMEN LN
SANTA MARIA CA
93458-7769
US

IV. Provider business mailing address

401 E CYPRESS AVE
LOMPOC CA
93436-6806
US

V. Phone/Fax

Practice location:
  • Phone: 805-803-8700
  • Fax:
Mailing address:
  • Phone: 805-737-6690
  • Fax: 805-737-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1FTXCYGZLJKVEDNS
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: