Healthcare Provider Details

I. General information

NPI: 1033943865
Provider Name (Legal Business Name): ELIANNI S ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3357 W VINE ST STE 103
KISSIMMEE FL
34741-4664
US

IV. Provider business mailing address

2801 GRANADA BLVD
KISSIMMEE FL
34746-3693
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-6255
  • Fax: 407-201-7195
Mailing address:
  • Phone: 786-547-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: