Healthcare Provider Details

I. General information

NPI: 1316712482
Provider Name (Legal Business Name): ALESSA ESCUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 CROSS PINE CT
LAKE WORTH FL
33467-2367
US

IV. Provider business mailing address

5160 LAS VERDES CIR APT 317
DELRAY BEACH FL
33484-8029
US

V. Phone/Fax

Practice location:
  • Phone: 561-223-8076
  • Fax: 561-584-5372
Mailing address:
  • Phone: 941-567-8166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-306229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: