Healthcare Provider Details

I. General information

NPI: 1184052094
Provider Name (Legal Business Name): ANJELICA ESCOBEDO CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 ERRINGER RD SUITE 202
SIMI VALLEY CA
93065-3583
US

IV. Provider business mailing address

1633 ERRINGER RD SUITE 202
SIMI VALLEY CA
93065-3583
US

V. Phone/Fax

Practice location:
  • Phone: 805-206-6084
  • Fax:
Mailing address:
  • Phone: 805-206-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: