Healthcare Provider Details

I. General information

NPI: 1801426176
Provider Name (Legal Business Name): ELENICE CLASS ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST
TORRANCE CA
90502-2059
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-5001
  • Fax:
Mailing address:
  • Phone: 424-306-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: