Healthcare Provider Details

I. General information

NPI: 1770136350
Provider Name (Legal Business Name): MARTA ESCALONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SW 8TH ST
MIAMI FL
33130-3705
US

IV. Provider business mailing address

1220 SW 5TH ST APT 21
MIAMI FL
33135-4041
US

V. Phone/Fax

Practice location:
  • Phone: 786-301-2383
  • Fax:
Mailing address:
  • Phone: 786-301-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA74382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: