Provider Demographics
NPI:1336819762
Name:ESCALONA GURRI, DAVEL A
Entity Type:Individual
Prefix:
First Name:DAVEL
Middle Name:A
Last Name:ESCALONA GURRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W 25TH CT APT 305
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4443
Mailing Address - Country:US
Mailing Address - Phone:786-877-4206
Mailing Address - Fax:
Practice Address - Street 1:5701 W 25TH CT APT 305
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4443
Practice Address - Country:US
Practice Address - Phone:786-877-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-165361106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty