Healthcare Provider Details

I. General information

NPI: 1033472105
Provider Name (Legal Business Name): MELINDA ESPIRITU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W SAMPLE RD APT 206
CORAL SPRINGS FL
33067-3234
US

IV. Provider business mailing address

5800 W SAMPLE RD APT 206
CORAL SPRINGS FL
33067-3234
US

V. Phone/Fax

Practice location:
  • Phone: 954-798-7795
  • Fax:
Mailing address:
  • Phone: 954-798-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1215923
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: