Provider Demographics
NPI:1023285152
Name:LESCOBAR PA
Entity type:Organization
Organization Name:LESCOBAR PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALCIDES
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-322-8586
Mailing Address - Street 1:3510 NE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-8129
Mailing Address - Country:US
Mailing Address - Phone:954-322-8586
Mailing Address - Fax:954-322-8581
Practice Address - Street 1:4440 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3535
Practice Address - Country:US
Practice Address - Phone:954-322-8586
Practice Address - Fax:954-322-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5059181OtherAETNA
FL12692OtherBCBS
FL3481ASOSOtherNHP
FL3481ASOSOtherNHP
FLK5939Medicare PIN
FL5059181OtherAETNA