Provider Demographics
NPI:1639571383
Name:ESCOBALES, GLORIMAR (BS)
Entity Type:Individual
Prefix:MISS
First Name:GLORIMAR
Middle Name:
Last Name:ESCOBALES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3392
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-3392
Mailing Address - Country:US
Mailing Address - Phone:787-922-8490
Mailing Address - Fax:
Practice Address - Street 1:BUZON 1684 BO SANTANA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-922-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5562355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR556OtherLICENCIA PROFESIONAL DE TERAPISTA DEL HABLA-LENGUAJE