Provider Demographics
NPI:1871257303
Name:ESCOBAR PAYARES, DONA
Entity Type:Individual
Prefix:
First Name:DONA
Middle Name:
Last Name:ESCOBAR PAYARES
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 1:9113 MELLOW CORAL ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8436
Mailing Address - Country:US
Mailing Address - Phone:863-877-8328
Mailing Address - Fax:
Practice Address - Street 1:9113 MELLOW CORAL ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8436
Practice Address - Country:US
Practice Address - Phone:863-877-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112203400Medicaid