Healthcare Provider Details

I. General information

NPI: 1538696067
Provider Name (Legal Business Name): JOSEPH ESPOSITO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 05/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 E BROADWAY BLVD STE 200
TUCSON AZ
85711-3574
US

IV. Provider business mailing address

PO BOX 273326
FORT COLLINS CO
80527-3326
US

V. Phone/Fax

Practice location:
  • Phone: 310-998-7540
  • Fax:
Mailing address:
  • Phone: 866-996-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT23127
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: