Healthcare Provider Details

I. General information

NPI: 1689616377
Provider Name (Legal Business Name): LOURDES ESCALONA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TORRANCE BLVD EM DEPT
TORRANCE CA
90503-4607
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE 121
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-7676
  • Fax: 405-749-4561
Mailing address:
  • Phone: 405-751-4664
  • Fax: 405-749-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberG71420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: