Healthcare Provider Details

I. General information

NPI: 1215426234
Provider Name (Legal Business Name): LIZ LAURENT ESPINOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 NE 15TH PL
CAPE CORAL FL
33909-3405
US

IV. Provider business mailing address

3135 NE 15TH PL
CAPE CORAL FL
33909-3405
US

V. Phone/Fax

Practice location:
  • Phone: 786-307-6561
  • Fax:
Mailing address:
  • Phone: 786-307-6561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: