Healthcare Provider Details

I. General information

NPI: 1871051391
Provider Name (Legal Business Name): STEPHANIE ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E LAKE AVE
WATSONVILLE CA
95076-4826
US

IV. Provider business mailing address

335 E LAKE AVE
WATSONVILLE CA
95076-4826
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-6445
  • Fax:
Mailing address:
  • Phone: 831-728-6445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: