Healthcare Provider Details

I. General information

NPI: 1033615695
Provider Name (Legal Business Name): PEDRO MARIO ESPINO-GROSSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 CORAL RIDGE DR STE 106
CORAL SPRINGS FL
33076-3379
US

IV. Provider business mailing address

5850 CORAL RIDGE DR STE 106
CORAL SPRINGS FL
33076-3379
US

V. Phone/Fax

Practice location:
  • Phone: 954-714-8200
  • Fax: 954-840-2626
Mailing address:
  • Phone: 954-714-8200
  • Fax: 954-840-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME162900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: