Healthcare Provider Details

I. General information

NPI: 1295373363
Provider Name (Legal Business Name): ALEXANDRA MARIE ESCALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7241 SW 63RD AVE STE 101A
SOUTH MIAMI FL
33143-4838
US

IV. Provider business mailing address

7241 SW 63RD AVE STE 101A
SOUTH MIAMI FL
33143-4838
US

V. Phone/Fax

Practice location:
  • Phone: 305-397-8679
  • Fax: 833-817-6434
Mailing address:
  • Phone: 305-397-8679
  • Fax: 833-817-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: