Provider Demographics
NPI:1891200481
Name:ESCOBAR, NATALIE MARIA
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIA
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 1:1060 S BROOKHURST RD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-3709
Mailing Address - Country:US
Mailing Address - Phone:714-449-1339
Mailing Address - Fax:714-449-1289
Practice Address - Street 1:1060 S BROOKHURST RD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-3709
Practice Address - Country:US
Practice Address - Phone:714-449-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF100603106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist