Provider Demographics
NPI:1326411828
Name:ESCOBEDO, MONICA MARIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIA
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:MARIA
Other - Last Name:GARCIA HURTADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:SUITE 504E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-595-6200
Practice Address - Fax:305-598-4071
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9109260OtherFLORIDA PHYSICIAN ASSISTANT LICENSE