Provider Demographics
NPI:1881389476
Name:ESCALERA, KRISTEN (LAC)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:ESCALERA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 S UNION AVE APT 614
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1662
Mailing Address - Country:US
Mailing Address - Phone:424-249-0209
Mailing Address - Fax:
Practice Address - Street 1:8358 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3917
Practice Address - Country:US
Practice Address - Phone:562-622-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15979171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty