Provider Demographics
NPI:1184052094
Name:ESCOBEDO, ANJELICA (CMT)
Entity type:Individual
Prefix:MRS
First Name:ANJELICA
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 ERRINGER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3583
Mailing Address - Country:US
Mailing Address - Phone:805-206-6084
Mailing Address - Fax:
Practice Address - Street 1:1633 ERRINGER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3583
Practice Address - Country:US
Practice Address - Phone:805-206-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA816225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist