Healthcare Provider Details

I. General information

NPI: 1174811400
Provider Name (Legal Business Name): PRISCILLA GABRIELA ESCALONA VILLASMIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15955 SW 96TH ST STE 200
MIAMI FL
33196-1272
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 786-467-3140
  • Fax: 786-533-9276
Mailing address:
  • Phone: 786-594-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number248347
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME160815
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number248347
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number39237
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: