Provider Demographics
NPI:1831347475
Name:ESCOBAR-MANLULU, LARISSA HEIDI
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:HEIDI
Last Name:ESCOBAR-MANLULU
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 1:333 W HARVARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3225
Mailing Address - Country:US
Mailing Address - Phone:805-525-1618
Mailing Address - Fax:
Practice Address - Street 1:333 W HARVARD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3225
Practice Address - Country:US
Practice Address - Phone:805-525-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical