Healthcare Provider Details

I. General information

NPI: 1457225682
Provider Name (Legal Business Name): MARVIN J ESPINOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 NE 5TH TER
FLORIDA CITY FL
33034-3293
US

IV. Provider business mailing address

497 NE 5TH TER
FLORIDA CITY FL
33034-3293
US

V. Phone/Fax

Practice location:
  • Phone: 786-283-0935
  • Fax:
Mailing address:
  • Phone: 786-283-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-477692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: