Provider Demographics
NPI:1932671864
Name:ESCAMILLA, SERGIO ENRIQUE (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:ENRIQUE
Last Name:ESCAMILLA
Suffix:
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19808 SANDPIPER PL UNIT 4
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-4338
Mailing Address - Country:US
Mailing Address - Phone:661-964-9616
Mailing Address - Fax:
Practice Address - Street 1:1401 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7922
Practice Address - Country:US
Practice Address - Phone:626-321-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8115237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist