Healthcare Provider Details

I. General information

NPI: 1932753688
Provider Name (Legal Business Name): LOREN DANIELA ESCOBAR CCC- SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7791 NW 46TH ST STE 210
DORAL FL
33166-5482
US

IV. Provider business mailing address

31 SE 5TH ST APT 3307
MIAMI FL
33131-2526
US

V. Phone/Fax

Practice location:
  • Phone: 305-878-0083
  • Fax: 305-477-7808
Mailing address:
  • Phone: 650-447-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA18330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: