Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | PA 21502 | CA |
NPI | 1053650416 |
---|---|
Provider Name | Ms. Juvy Escalante |
First Address | Oceanside, CA 92052-4325 |
Second Address | Vista, CA 92084-6002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2013 |
Last Update Date | 05/02/2013 |