Provider Demographics
NPI:1811036924
Name:ESCOBEDO, MARIA JESUS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:JESUS
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2867 W WINDHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-3468
Mailing Address - Country:US
Mailing Address - Phone:909-875-6620
Mailing Address - Fax:909-421-9219
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9468
Practice Address - Fax:909-421-9219
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 280261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811036924Medicare PIN