Healthcare Provider Details

I. General information

NPI: 1447625371
Provider Name (Legal Business Name): DEBORAH ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18465 PINES BLVD
PEMBROKE PINES FLORIDA
33029
UM

IV. Provider business mailing address

18465 PINES BLVD
PEMBROKE PINES FL
33029-1400
US

V. Phone/Fax

Practice location:
  • Phone: 786-218-3902
  • Fax:
Mailing address:
  • Phone: 786-218-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA80030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: