Healthcare Provider Details

I. General information

NPI: 1639448731
Provider Name (Legal Business Name): MR. VICTOR ESCOLAR-CHUA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 SAINT GEORGE RD
WESTMINSTER CA
92683-4146
US

IV. Provider business mailing address

4060 ORANGE AVE
LONG BEACH CA
90807-3717
US

V. Phone/Fax

Practice location:
  • Phone: 714-725-0000
  • Fax: 714-230-6331
Mailing address:
  • Phone: 800-659-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAT 6619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: