Provider Demographics
NPI:1841762820
Name:GIMENEZ ESCALANTE, FRANK DAVID (SA-C)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:DAVID
Last Name:GIMENEZ ESCALANTE
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 SW 60TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4046
Mailing Address - Country:US
Mailing Address - Phone:786-603-1825
Mailing Address - Fax:
Practice Address - Street 1:2935 SW 60TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4046
Practice Address - Country:US
Practice Address - Phone:786-603-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-400246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant