Healthcare Provider Details

I. General information

NPI: 1780044206
Provider Name (Legal Business Name): MONICA ESCALONA ITDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13590 SW 134TH AVE SUITE 107
MIAMI FL
33186-4561
US

IV. Provider business mailing address

800 PARKVIEW DR APT 811
HALLANDALE BEACH FL
33009-2978
US

V. Phone/Fax

Practice location:
  • Phone: 786-732-6646
  • Fax: 786-842-3218
Mailing address:
  • Phone: 305-834-2061
  • Fax: 786-842-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: