Provider Demographics
NPI:1194109108
Name:ESCAMILLA, CESAR JR (LPT)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:ESCAMILLA
Suffix:JR
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WEST ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3211
Mailing Address - Country:US
Mailing Address - Phone:626-755-4998
Mailing Address - Fax:
Practice Address - Street 1:425 WEST ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3211
Practice Address - Country:US
Practice Address - Phone:626-755-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38150167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician