Provider Demographics
NPI:1033375431
Name:ESCAMILLA, ELVIRA DIANE
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:DIANE
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10443 SLATER AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7708
Mailing Address - Country:US
Mailing Address - Phone:714-378-9760
Mailing Address - Fax:
Practice Address - Street 1:16480 HARBOR BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92708-1361
Practice Address - Country:US
Practice Address - Phone:714-418-9606
Practice Address - Fax:714-418-1575
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator