Healthcare Provider Details

I. General information

NPI: 1124517933
Provider Name (Legal Business Name): OLGA LIDIA ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 SW 88TH ST STE 220
MIAMI FL
33186-1513
US

IV. Provider business mailing address

6960 NW 177TH ST # N103
HIALEAH FL
33015-6270
US

V. Phone/Fax

Practice location:
  • Phone: 786-227-6823
  • Fax:
Mailing address:
  • Phone: 786-326-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: