Healthcare Provider Details

I. General information

NPI: 1053717397
Provider Name (Legal Business Name): MERCEDES ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25694 SW 124TH PL
HOMESTEAD FL
33032-5833
US

IV. Provider business mailing address

25694 SW 124TH PL
HOMESTEAD FL
33032-5833
US

V. Phone/Fax

Practice location:
  • Phone: 786-379-3704
  • Fax:
Mailing address:
  • Phone: 786-379-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: