Healthcare Provider Details

I. General information

NPI: 1841644655
Provider Name (Legal Business Name): MR. JUAN ALBERTO ESCALERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 CALLE FELIPE ROEY
SAN JUAN PR
00924-3411
US

IV. Provider business mailing address

CALLE FELIPE ROEY #872
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 939-475-3013
  • Fax:
Mailing address:
  • Phone: 939-475-3013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22394
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: