Provider Demographics
NPI:1225573942
Name:ESCOBAR, EDWARD D (BCBA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 CENTER COURT DR STE 211
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3668
Mailing Address - Country:US
Mailing Address - Phone:626-339-4999
Mailing Address - Fax:626-587-4841
Practice Address - Street 1:2920 INLAND EMPIRE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-6582
Practice Address - Country:US
Practice Address - Phone:909-303-3595
Practice Address - Fax:909-303-3594
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-37492103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst