Healthcare Provider Details

I. General information

NPI: 1851583926
Provider Name (Legal Business Name): RICARDO ESPINOLA MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 MOUNT EVEREST BLVD
SAN DIEGO CA
92117-4847
US

IV. Provider business mailing address

972 HEMLOCK AVE
IMPERIAL BEACH CA
91932-3435
US

V. Phone/Fax

Practice location:
  • Phone: 858-573-5971
  • Fax:
Mailing address:
  • Phone: 619-429-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: