Healthcare Provider Details

I. General information

NPI: 1710397419
Provider Name (Legal Business Name): YOANDER ESPINOSA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7581 W 4TH CT
HIALEAH FL
33014-4204
US

IV. Provider business mailing address

7581 W 4TH CT
HIALEAH FL
33014-4204
US

V. Phone/Fax

Practice location:
  • Phone: 305-490-9913
  • Fax:
Mailing address:
  • Phone: 305-490-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 24322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: