Healthcare Provider Details

I. General information

NPI: 1275586109
Provider Name (Legal Business Name): PAMELA T. ESCALANTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/01/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 BIRD RD STE 722
MIAMI FL
33175-8101
US

IV. Provider business mailing address

11760 BIRD RD STE 722
MIAMI FL
33175-8101
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-1883
  • Fax: 305-553-1887
Mailing address:
  • Phone: 305-559-1883
  • Fax: 305-553-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103514
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: