Provider Demographics
NPI:1225162241
Name:ESCOBAR, GINA (LAC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 RIGG ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4204
Mailing Address - Country:US
Mailing Address - Phone:831-419-7885
Mailing Address - Fax:831-427-3236
Practice Address - Street 1:621 WATER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4146
Practice Address - Country:US
Practice Address - Phone:831-419-7885
Practice Address - Fax:831-427-3236
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10975171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist