Healthcare Provider Details

I. General information

NPI: 1326333964
Provider Name (Legal Business Name): JORGE LUIS ESPINOSA M.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 06/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7760 W 20TH AVE STE 1
HIALEAH FL
33016-1829
US

IV. Provider business mailing address

7760 W 20TH AVE STE 1
HIALEAH FL
33016-1829
US

V. Phone/Fax

Practice location:
  • Phone: 305-819-8755
  • Fax: 305-819-8755
Mailing address:
  • Phone: 305-819-8755
  • Fax: 305-819-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA57857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: