Provider Demographics
NPI:1629257324
Name:CALANA ESCOBAR, MINERVA C (MA)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:C
Last Name:CALANA ESCOBAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 NW 36TH ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6978
Mailing Address - Country:US
Mailing Address - Phone:305-871-2238
Mailing Address - Fax:
Practice Address - Street 1:6555 NW 36TH ST
Practice Address - Street 2:SUITE #200
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6978
Practice Address - Country:US
Practice Address - Phone:305-871-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 51723225700000X
FLPTA25872225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist