Provider Demographics
NPI:1487366910
Name:ESCOBAR, JOSE ALBERTO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALBERTO
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 CINDERELLA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2509
Mailing Address - Country:US
Mailing Address - Phone:323-395-8130
Mailing Address - Fax:
Practice Address - Street 1:520 NEWPORT CENTER DR STE 550
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7020
Practice Address - Country:US
Practice Address - Phone:855-430-9429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-22-244846106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician