Healthcare Provider Details

I. General information

NPI: 1700019171
Provider Name (Legal Business Name): MS. ROSA ELVIRA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAMINO GARDENS BLVD THE BOCA CENTER FOR HEALING SUITE 101
BOCA RATON FL
33432-5822
US

IV. Provider business mailing address

3201 CORAL SPRINGS DR
CORAL SPRINGS FL
33065-3803
US

V. Phone/Fax

Practice location:
  • Phone: 561-452-4030
  • Fax:
Mailing address:
  • Phone: 561-452-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA52053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: