Provider Demographics
NPI:1659053106
Name:HERNANDEZ ESCOBEDO, GIRASOL (NP)
Entity Type:Individual
Prefix:
First Name:GIRASOL
Middle Name:
Last Name:HERNANDEZ ESCOBEDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GIRASOL
Other - Middle Name:
Other - Last Name:OLIVARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 1200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2467
Practice Address - Country:US
Practice Address - Phone:323-268-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily