Provider Demographics
NPI:1013671890
Name:ESCUDERO, ALBA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ALBA
Middle Name:
Last Name:ESCUDERO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18021 BISCAYNE BLVD APT 501
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2517
Mailing Address - Country:US
Mailing Address - Phone:786-728-6368
Mailing Address - Fax:
Practice Address - Street 1:4040 NE 2ND AVE STE 413
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3550
Practice Address - Country:US
Practice Address - Phone:305-767-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-173401106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician