Healthcare Provider Details

I. General information

NPI: 1558241786
Provider Name (Legal Business Name): JUAN JOSE ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21245 NE 8TH PL APT 5
MIAMI FL
33179-1303
US

IV. Provider business mailing address

21245 NE 8TH PL APT 5
MIAMI FL
33179-1303
US

V. Phone/Fax

Practice location:
  • Phone: 954-716-3498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: