Healthcare Provider Details

I. General information

NPI: 1336656164
Provider Name (Legal Business Name): CHRISTIAN GIOVANNY ESCALERA MOLINA SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. VILLA PINARES PASEO CALMA 139
VEGA BAJA PR
00693
US

IV. Provider business mailing address

URB VILLA PINARES PASEO CALMA 139
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-226-4670
  • Fax:
Mailing address:
  • Phone: 787-226-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2036
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: