Provider Demographics
NPI:1801531918
Name:ESCOBEDO, MAGDALENA (C-SLPA)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:C-SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAINE AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-1137
Mailing Address - Country:US
Mailing Address - Phone:714-610-3285
Mailing Address - Fax:
Practice Address - Street 1:3722 KATELLA AVE STE C
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3102
Practice Address - Country:US
Practice Address - Phone:562-270-2970
Practice Address - Fax:562-685-0621
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71592355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7159OtherSTATE LICENSE