Provider Demographics
NPI:1851346084
Name:ESCOBEDO, JODIE A (MD)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:A
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JODIE
Other - Middle Name:ANNROE
Other - Last Name:ESCOBEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2143 S SEPULVEDA BLVD
Mailing Address - Street 2:300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5733
Mailing Address - Country:US
Mailing Address - Phone:310-575-3100
Mailing Address - Fax:310-575-3102
Practice Address - Street 1:2143 S SEPULVEDA BLVD
Practice Address - Street 2:300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5733
Practice Address - Country:US
Practice Address - Phone:310-575-3100
Practice Address - Fax:310-575-3102
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0091750Medicaid
CAWG80677CMedicare ID - Type Unspecified
CAGR0091750Medicaid