Provider Demographics
NPI:1639417645
Name:ESCOTO, EDWARD C
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:ESCOTO
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 1:4234 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7624
Mailing Address - Country:US
Mailing Address - Phone:786-393-4962
Mailing Address - Fax:305-883-4885
Practice Address - Street 1:4234 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7624
Practice Address - Country:US
Practice Address - Phone:786-393-4962
Practice Address - Fax:305-883-4885
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA71655225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist