Basic Information
| Provider Information | |||||||||
| NPI: | 1649319435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESCALERA | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | PHILLIP | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 E COOLEY DR | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923243934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094330445 | ||||||||
| FaxNumber: | 9094330556 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 E COOLEY DR | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923243934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094330445 | ||||||||
| FaxNumber: | 9094330556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.