MEDICARE: DANIELA BONILLA ESCAMILLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1730027103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELA BONILLA ESCAMILLA

Provider Business Mailing Address
First Line	:	16385 NW 12TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-1303
Country	:	US
Telephone Number	:	954-605-0378
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 N PINE ISLAND RD
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33351-6005
Country	:	US
Telephone Number	:	954-605-0378
Fax Number	:	954-530-4292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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