Healthcare Provider Details

I. General information

NPI: 1508597758
Provider Name (Legal Business Name): MR. WILLIAM B ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 TECH BLVD STE 122
TAMPA FL
33619-7822
US

IV. Provider business mailing address

2021 9TH ST
SARASOTA FL
34237-3401
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 561-602-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-5168-415574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: