Provider Demographics
NPI:1467879239
Name:ESCOBEDO, MARIA FERNANDA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:ESCOBEDO
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 1:2015 CABRILLO LN
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-5419
Mailing Address - Country:US
Mailing Address - Phone:866-936-7838
Mailing Address - Fax:866-936-7840
Practice Address - Street 1:2015 CABRILLO LN
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-5419
Practice Address - Country:US
Practice Address - Phone:866-936-7838
Practice Address - Fax:866-936-7840
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ABA SUPPORT STAFF103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst