Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | NA | CA |
NPI | 1225657331 |
---|---|
Provider Name | Miss Samantha Lillian Escalera |
First Address | Pico Rivera, CA 90660-4743 |
Second Address | Pico Rivera, CA 90660-4743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 09/04/2020 |