Healthcare Provider Details

I. General information

NPI: 1972181923
Provider Name (Legal Business Name): ELIA MARIA ESCALONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12575 PALM RD
NORTH MIAMI FL
33181-2611
US

IV. Provider business mailing address

12575 PALM RD
NORTH MIAMI FL
33181-2611
US

V. Phone/Fax

Practice location:
  • Phone: 786-553-3146
  • Fax:
Mailing address:
  • Phone: 786-553-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-128819
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: