Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | CA | |
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003465659 |
---|---|
Provider Name | Eva Bernadette Escobedo |
First Address | Los Angeles, CA 90041-1744 |
Second Address | Pasadena, CA 91105-2711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2019 |
Last Update Date | 04/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
$$$$$$$$$ | (05) | CA |