Provider Demographics
NPI:1942448923
Name:ESCOBAR, ALBERT QUIRAP (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:QUIRAP
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1538 W DELVALE ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4545
Mailing Address - Country:US
Mailing Address - Phone:323-717-0450
Mailing Address - Fax:
Practice Address - Street 1:433 N 4TH ST
Practice Address - Street 2:STE 216
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4309
Practice Address - Country:US
Practice Address - Phone:323-530-0433
Practice Address - Fax:323-530-0434
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19096261QP2000X
CA19096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty