Provider Demographics
NPI:1851836639
Name:ESCOBAR, ERMILA
Entity Type:Individual
Prefix:
First Name:ERMILA
Middle Name:
Last Name:ESCOBAR
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 1:27268 VIA INDUSTRIA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3751
Mailing Address - Country:US
Mailing Address - Phone:951-265-6504
Mailing Address - Fax:
Practice Address - Street 1:27268 VIA INDUSTRIA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3751
Practice Address - Country:US
Practice Address - Phone:951-265-6504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician