Healthcare Provider Details

I. General information

NPI: 1922756220
Provider Name (Legal Business Name): JENNIFER PAOLA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 SW 184TH ST
CUTLER BAY FL
33157-6608
US

IV. Provider business mailing address

10920 SW 184TH ST
CUTLER BAY FL
33157-6608
US

V. Phone/Fax

Practice location:
  • Phone: 305-378-5775
  • Fax:
Mailing address:
  • Phone: 305-378-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: