Healthcare Provider Details

I. General information

NPI: 1730706722
Provider Name (Legal Business Name): SONIA ESCALERA RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S CHINOWTH ST
VISALIA CA
93277-1653
US

IV. Provider business mailing address

400 CHANNING WAY
EXETER CA
93221-1910
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-1177
  • Fax:
Mailing address:
  • Phone: 559-624-1177
  • Fax: 559-854-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: