Healthcare Provider Details

I. General information

NPI: 1194343590
Provider Name (Legal Business Name): YUDENIS ESCALONA MARTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2020
Last Update Date: 07/12/2020
Certification Date: 07/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9726 HAMMOCKS BLVD APT 102
MIAMI FL
33196-1550
US

IV. Provider business mailing address

9726 HAMMOCKS BLVD APT 102
MIAMI FL
33196-1550
US

V. Phone/Fax

Practice location:
  • Phone: 786-564-3054
  • Fax:
Mailing address:
  • Phone: 786-564-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-122824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: