=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477427474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESCOBAR MEDICAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2025
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9240 SW 72ND ST STE 241
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-271-1919
-----------------------------------------------------
Fax | 305-271-1919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18217 SW 148TH AVE RD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33187-1883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-879-6048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARIA KARLA ESCOBAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-879-6048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------