Provider Demographics
NPI:1497560460
Name:MORERA ESCOBAR, MELISA MASIEL
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:MASIEL
Last Name:MORERA ESCOBAR
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 1:917 NE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1424
Mailing Address - Country:US
Mailing Address - Phone:305-302-6307
Mailing Address - Fax:
Practice Address - Street 1:917 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1424
Practice Address - Country:US
Practice Address - Phone:305-302-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician