Provider Demographics
NPI:1922834670
Name:ESCAMILLA, ROBERTO CARLOS
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CARLOS
Last Name:ESCAMILLA
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 1:93 W 27TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1756
Mailing Address - Country:US
Mailing Address - Phone:754-215-8951
Mailing Address - Fax:
Practice Address - Street 1:93 W 27TH ST APT 8
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1756
Practice Address - Country:US
Practice Address - Phone:754-215-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1074986106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician