Healthcare Provider Details

I. General information

NPI: 1013649391
Provider Name (Legal Business Name): SANDRA ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 1ST ST
WOODLAND CA
95695-4023
US

IV. Provider business mailing address

598 N WALTON AVE APT 19
YUBA CITY CA
95993-9351
US

V. Phone/Fax

Practice location:
  • Phone: 530-285-3038
  • Fax:
Mailing address:
  • Phone: 408-647-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberASW110755
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW110755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: