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General NPI Number Information
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NPI Number | 1093449530
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Entity Type | Individual
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Provider Name | ILIONIS ESCOBAR ROJAS SA-C
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Gender | Male
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 3506 TROPICANA PKWY W
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City | CAPE CORAL
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State | FL
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Zip | 33993-5621
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Country | US
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Telephone | 239-224-2422
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Fax |
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Provider Business Mailing Address
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Address Line | 212 THREE ISLANDS BLVD # 1-103
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-7348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 22-183
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License Number State | FL
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