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General NPI Number Information
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NPI Number | 1942080593
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Entity Type | Individual
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Provider Name | CASEY DYAN ESCOBEDO AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 222 N PACIFIC COAST HWY STE 1420
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City | EL SEGUNDO
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State | CA
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Zip | 90245-5648
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Country | US
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Telephone | 877-878-3289
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Fax | 877-817-3227
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Provider Business Mailing Address
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Address Line | 222 N PACIFIC COAST HWY STE 2175
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City | EL SEGUNDO
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State | CA
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Zip | 90245-5639
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Country | US
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Telephone | 877-878-3289
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Fax | 877-817-3227
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1136669
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License Number State | TX
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