Healthcare Provider Details

I. General information

NPI: 1730675455
Provider Name (Legal Business Name): JAQUELYN MARLENE ESCOBAR BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24525 TOWN CENTER DRIVE
VALENCIA CA
91355
US

IV. Provider business mailing address

24525 TOWN CENTER DRIVE
VALENCIA CA
91355
US

V. Phone/Fax

Practice location:
  • Phone: 661-200-2300
  • Fax: 661-200-2308
Mailing address:
  • Phone: 661-200-2300
  • Fax: 661-200-2308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: