Provider Demographics
NPI:1508413931
Name:ESCOBEDO, GUADALUPE (BCABA)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2627
Mailing Address - Country:US
Mailing Address - Phone:619-691-1880
Mailing Address - Fax:619-691-5937
Practice Address - Street 1:410 S 4TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3009
Practice Address - Country:US
Practice Address - Phone:760-353-8500
Practice Address - Fax:760-353-8502
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-19-9774103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst