Healthcare Provider Details

I. General information

NPI: 1184214975
Provider Name (Legal Business Name): CARLOS A ESCABI LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 E SUNRISE BLVD STE 801
FORT LAUDERDALE FL
33304-1407
US

IV. Provider business mailing address

609 NE 13TH AVE APT 103
FORT LAUDERDALE FL
33304-2837
US

V. Phone/Fax

Practice location:
  • Phone: 954-380-2003
  • Fax:
Mailing address:
  • Phone: 954-380-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP-4160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: