Healthcare Provider Details

I. General information

NPI: 1699270546
Provider Name (Legal Business Name): IDANIA BARBARA ESPINOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8249 SW 149TH CT APT 208
MIAMI FL
33193-3104
US

IV. Provider business mailing address

8249 SW 149TH CT APT 208
MIAMI FL
33193-3104
US

V. Phone/Fax

Practice location:
  • Phone: 786-370-8241
  • Fax:
Mailing address:
  • Phone: 786-370-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00000000000000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: