MEDICARE: MIRNA ESCALANTE

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	183700000X	Pharmacy Technician	65689	CA

General Provider Information

NPI Number	:	1558290338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRNA ESCALANTE

Provider Business Mailing Address
First Line	:	645 N ARDMORE AVE APT 212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-2023
Country	:	US
Telephone Number	:	213-575-0020
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 N ARDMORE AVE APT 212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-2023
Country	:	US
Telephone Number	:	213-575-0020
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “ MIRNA ESCALANTE ” Practice Location

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