Provider Demographics
NPI:1265667406
Name:ESCOBEDO, MARTIN
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 S TAYLOR AVE
Mailing Address - Street 2:4
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-5879
Mailing Address - Country:US
Mailing Address - Phone:213-480-3462
Mailing Address - Fax:213-252-8878
Practice Address - Street 1:841 S TAYLOR AVE
Practice Address - Street 2:4
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-5879
Practice Address - Country:US
Practice Address - Phone:213-480-3462
Practice Address - Fax:213-252-8878
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health