Provider Demographics
NPI:1861862468
Name:ESCOBAR, JUSTINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:ESCOBAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6199 CANTERBURY DR
Mailing Address - Street 2:UNIT 203
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7152
Mailing Address - Country:US
Mailing Address - Phone:310-686-3813
Mailing Address - Fax:
Practice Address - Street 1:2001 WILSHIRE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5641
Practice Address - Country:US
Practice Address - Phone:310-829-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15637225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand