MEDICARE: KATHY GUISSEL ESCOBAR M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	150236	CA

General Provider Information

NPI Number	:	1194373225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY GUISSEL ESCOBAR M.S.

Provider Business Mailing Address
First Line	:	8616 LA TIJERA BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3945
Country	:	US
Telephone Number	:	818-862-5567
Fax Number	:

Provider Business Practice Location Address
First Line	:	14540 BLYTHE ST APT 210
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-6085
Country	:	US
Telephone Number	:	818-272-3213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2019
Last Update Date	:	10/03/2024

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