Healthcare Provider Details

I. General information

NPI: 1346366010
Provider Name (Legal Business Name): JOSE F ESPAILLAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 GABILAN DR
SOLEDAD CA
93960-3550
US

IV. Provider business mailing address

HC 6 BOX 74215
CAGUAS PR
00725-9539
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-8740
  • Fax:
Mailing address:
  • Phone: 352-603-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME103250
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA101837
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME103250
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA101837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: