Provider Demographics
NPI:1407232465
Name:ESCALANTE, URSULA
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:
Last Name:ESCALANTE
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 1:201 S MILLER ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5233
Mailing Address - Country:US
Mailing Address - Phone:805-925-9811
Mailing Address - Fax:805-925-9706
Practice Address - Street 1:201 S MILLER ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5233
Practice Address - Country:US
Practice Address - Phone:805-925-9811
Practice Address - Fax:805-925-9706
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health