Provider Demographics
NPI:1457054793
Name:ESCOBAR, CHARLENE GALBAN
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:GALBAN
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 1:39782 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3551
Mailing Address - Country:US
Mailing Address - Phone:951-676-0703
Mailing Address - Fax:
Practice Address - Street 1:39782 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3551
Practice Address - Country:US
Practice Address - Phone:951-676-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATHC182033183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician