Healthcare Provider Details

I. General information

NPI: 1821233032
Provider Name (Legal Business Name): NUBE ROSA ESCOBAR RODRIGUEZ AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 GREENWALD WAY N
KISSIMMEE FL
34741-0728
US

IV. Provider business mailing address

13859 MASKAWA AVE
ORLANDO FL
32827-7599
US

V. Phone/Fax

Practice location:
  • Phone: 631-612-8437
  • Fax:
Mailing address:
  • Phone: 631-612-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002918
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number018842
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 11439
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: