Provider Demographics
NPI:1043514516
Name:ESCOBAR, DAIMARELIS
Entity Type:Individual
Prefix:
First Name:DAIMARELIS
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 NW 22ND CT
Mailing Address - Street 2:APT 7-A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142
Mailing Address - Country:US
Mailing Address - Phone:786-468-6472
Mailing Address - Fax:
Practice Address - Street 1:12555 ORANGE DR
Practice Address - Street 2:SUITE 222
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330
Practice Address - Country:US
Practice Address - Phone:954-862-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001363600Medicaid