Healthcare Provider Details

I. General information

NPI: 1184544066
Provider Name (Legal Business Name): MARICARMEN ESCOBEDO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WIKIUP DR
SANTA ROSA CA
95403-1375
US

IV. Provider business mailing address

2045 BAY MEADOW DR
SANTA ROSA CA
95403-2097
US

V. Phone/Fax

Practice location:
  • Phone: 707-920-5434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: