Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023264009 |
---|---|
Provider Name | Mr. Gerard Escalante |
First Address | Commerce, CA 90040-1200 |
Second Address | Commerce, CA 90040-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2008 |
Last Update Date | 14/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
95-2633765 | MEDI-CAL (01) | CA |