Healthcare Provider Details

I. General information

NPI: 1972359743
Provider Name (Legal Business Name): ALLANLID ESCAURIDO MENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14583 SW 115TH ST
MIAMI FL
33186-6672
US

IV. Provider business mailing address

14583 SW 115TH ST
MIAMI FL
33186-6672
US

V. Phone/Fax

Practice location:
  • Phone: 786-642-7932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-335365
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: