Provider Demographics
NPI:1093390668
Name:ESCOBAR, LARITZA
Entity Type:Individual
Prefix:
First Name:LARITZA
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 1:6357 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4819
Mailing Address - Country:US
Mailing Address - Phone:786-484-6778
Mailing Address - Fax:
Practice Address - Street 1:6357 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4819
Practice Address - Country:US
Practice Address - Phone:786-484-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty