MEDICARE: PERLA ESPINOZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA 13820	FL

General Provider Information

NPI Number	:	1114395365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERLA ESPINOZA

Provider Business Mailing Address
First Line	:	810 N 32ND CT
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6130
Country	:	US
Telephone Number	:	754-802-0422
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 NW 77TH AVE
Second Line	:	#3
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2530
Country	:	US
Telephone Number	:	786-429-7313
Fax Number	:	786-391-2963

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	09/04/2015

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Directions to “ PERLA ESPINOZA ” Practice Location

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