Provider Demographics
NPI:1265520761
Name:ESCOBAR, EVELYN ERNESTINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ERNESTINE
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 BEAR ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2964
Mailing Address - Country:US
Mailing Address - Phone:714-437-9663
Mailing Address - Fax:714-437-9631
Practice Address - Street 1:3140 BEAR ST STE 200
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2964
Practice Address - Country:US
Practice Address - Phone:714-437-9663
Practice Address - Fax:714-437-9631
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550860915OtherEIN