Provider Demographics
NPI:1306224803
Name:ESCALANTE, FABIOLA VANESSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:VANESSA
Last Name:ESCALANTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11470 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4130
Mailing Address - Country:US
Mailing Address - Phone:323-445-8785
Mailing Address - Fax:
Practice Address - Street 1:11470 DELANO ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4130
Practice Address - Country:US
Practice Address - Phone:323-445-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA720181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist