Healthcare Provider Details

I. General information

NPI: 1528299526
Provider Name (Legal Business Name): MR. PEDRO T. ESCUDERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date: 04/27/2025
Reactivation Date: 09/25/2025

III. Provider practice location address

15379 SW 24TH ST
MIAMI FL
33185-5739
US

IV. Provider business mailing address

15379 SW 24TH ST
MIAMI FL
33185-5739
US

V. Phone/Fax

Practice location:
  • Phone: 305-439-7590
  • Fax:
Mailing address:
  • Phone: 305-989-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT25827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: