MEDICARE: MR. FERNANDO JAVIER ESCOBAR CMT, L.AC.

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	171100000X	Acupuncturist	13195	CA
2	225700000X	Massage Therapist	837	CA

General Provider Information

NPI Number	:	1952624447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FERNANDO JAVIER ESCOBAR CMT, L.AC.

Provider Business Mailing Address
First Line	:	10438 CULVER BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3466
Country	:	US
Telephone Number	:	310-963-9521
Fax Number	:

Provider Business Practice Location Address
First Line	:	10438 CULVER BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3466
Country	:	US
Telephone Number	:	310-963-9521
Fax Number	:

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

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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