Provider Demographics
NPI:1255603395
Name:ESCALERA-DAVILA, CAROL IVETTE (LCDA)
Entity type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:IVETTE
Last Name:ESCALERA-DAVILA
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 FLOR DE OTONO
Mailing Address - Street 2:RIVER GARDEN
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3380
Mailing Address - Country:US
Mailing Address - Phone:787-409-8479
Mailing Address - Fax:
Practice Address - Street 1:413 CALLE FLOR DE OTONO
Practice Address - Street 2:RIVER GARDEN
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3380
Practice Address - Country:US
Practice Address - Phone:787-409-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist