Healthcare Provider Details

I. General information

NPI: 1265044143
Provider Name (Legal Business Name): VANESSA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TORRANCE BLVD
TORRANCE CA
90503-4607
US

IV. Provider business mailing address

4101 TORRANCE BLVD
TORRANCE CA
90503-4607
US

V. Phone/Fax

Practice location:
  • Phone: 310-486-9166
  • Fax:
Mailing address:
  • Phone: 310-486-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: