Provider Demographics
NPI:1023631090
Name:ESCALANTE ZERPA, VICMA FLOR (PA DERMATOLOGY)
Entity type:Individual
Prefix:
First Name:VICMA
Middle Name:FLOR
Last Name:ESCALANTE ZERPA
Suffix:
Gender:F
Credentials:PA DERMATOLOGY
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:786-302-0934
Mailing Address - Fax:
Practice Address - Street 1:2030 S DOUGLAS RD STE 216
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4620
Practice Address - Country:US
Practice Address - Phone:305-610-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2064-PA363AS0400X
FLPACN38363A00000X
WI14-518246ZC0007X
FLTPPA669363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical