Provider Demographics
NPI:1891101762
Name:ESCOBAR, CINDY CRISABEL (MS)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:CRISABEL
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1045
Mailing Address - Country:US
Mailing Address - Phone:323-640-1162
Mailing Address - Fax:
Practice Address - Street 1:800 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-9060
Practice Address - Country:US
Practice Address - Phone:562-328-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF79020101YM0800X
106H00000X
CA110874106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health