Provider Demographics
NPI:1366274110
Name:ESCAMILLA, DANIEL (CMT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ESCAMILLA
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2935
Mailing Address - Country:US
Mailing Address - Phone:714-230-5625
Mailing Address - Fax:
Practice Address - Street 1:2633 W COAST HWY # 8
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4777
Practice Address - Country:US
Practice Address - Phone:949-881-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist