Healthcare Provider Details

I. General information

NPI: 1790147387
Provider Name (Legal Business Name): DENNIS ESPEJO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

4740 BRADLEY BLVD APT 223
CHEVY CHASE MD
20815-6354
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-3000
  • Fax:
Mailing address:
  • Phone: 818-481-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO034856
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: