Provider Demographics
NPI:1730675455
Name:ESCOBAR, JAQUELYN MARLENE (BS)
Entity type:Individual
Prefix:MS
First Name:JAQUELYN
Middle Name:MARLENE
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24525 TOWN CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-200-2300
Mailing Address - Fax:661-200-2308
Practice Address - Street 1:24525 TOWN CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-200-2300
Practice Address - Fax:661-200-2308
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker