Healthcare Provider Details

I. General information

NPI: 1992473227
Provider Name (Legal Business Name): MARIA PAULA ESPINOSA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

1083 IMPERIAL LAKE RD
WEST PALM BEACH FL
33413-1077
US

V. Phone/Fax

Practice location:
  • Phone: 816-655-7726
  • Fax: 813-655-5617
Mailing address:
  • Phone: 561-460-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: