Healthcare Provider Details

I. General information

NPI: 1952038135
Provider Name (Legal Business Name): IZES ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2022
Last Update Date: 08/07/2025
Certification Date: 07/28/2023
Deactivation Date: 07/28/2023
Reactivation Date: 08/07/2025

III. Provider practice location address

2453 GRAND CANAL BLVD STE A
STOCKTON CA
95207-8138
US

IV. Provider business mailing address

16782 VON KARMAN AVE STE 11
IRVINE CA
92606-2417
US

V. Phone/Fax

Practice location:
  • Phone: 855-223-7123
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax: 619-374-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: