Healthcare Provider Details

I. General information

NPI: 1063304830
Provider Name (Legal Business Name): ESCOBIO STAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6478 SW 12TH ST
WEST MIAMI FL
33144-5620
US

IV. Provider business mailing address

6478 SW 12TH ST
WEST MIAMI FL
33144-5620
US

V. Phone/Fax

Practice location:
  • Phone: 786-720-2458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LIDUAN ESCOBIO
Title or Position: CEO
Credential:
Phone: 786-720-2458