Healthcare Provider Details

I. General information

NPI: 1588474415
Provider Name (Legal Business Name): YAITMA ESCOBAR MIRABAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14257 SW 96TH TER
MIAMI FL
33186-7895
US

IV. Provider business mailing address

14257 SW 96TH TER
MIAMI FL
33186-7895
US

V. Phone/Fax

Practice location:
  • Phone: 786-853-6898
  • Fax:
Mailing address:
  • Phone: 786-853-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-399613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: