Healthcare Provider Details

I. General information

NPI: 1861862468
Provider Name (Legal Business Name): JUSTINE ESCOBAR OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUSTINE ESCOBAR OTR/L

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WILSHIRE BLVD SUITE 310
SANTA MONICA CA
90403-5641
US

IV. Provider business mailing address

6199 CANTERBURY DR UNIT 203
CULVER CITY CA
90230-7152
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-3320
  • Fax:
Mailing address:
  • Phone: 310-686-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number15637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: