Healthcare Provider Details

I. General information

NPI: 1043604887
Provider Name (Legal Business Name): OSCAR DAVID ESCALANTE MC 60452829
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 174TH ST NE
MARYSVILLE WA
98271-4743
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98207-5127
US

V. Phone/Fax

Practice location:
  • Phone: 360-454-1900
  • Fax: 360-454-1991
Mailing address:
  • Phone: 360-454-1900
  • Fax: 360-454-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC 60452829
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: