Healthcare Provider Details

I. General information

NPI: 1841804739
Provider Name (Legal Business Name): INGRID ESTHER ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 SE 25TH ST UNIT 208
HOMESTEAD FL
33035-2480
US

IV. Provider business mailing address

1543 SE 25TH ST UNIT 208
HOMESTEAD FL
33035-2480
US

V. Phone/Fax

Practice location:
  • Phone: 786-399-1587
  • Fax:
Mailing address:
  • Phone: 786-399-1587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-121342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: