Healthcare Provider Details

I. General information

NPI: 1407355563
Provider Name (Legal Business Name): ANGELICA ESPITIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W COLLEGE ST
FLORENCE AL
35630-5313
US

IV. Provider business mailing address

635 W COLLEGE ST
FLORENCE AL
35630-5313
US

V. Phone/Fax

Practice location:
  • Phone: 256-764-3431
  • Fax: 256-768-7462
Mailing address:
  • Phone: 256-764-3431
  • Fax: 256-768-7462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: