Healthcare Provider Details

I. General information

NPI: 1811760762
Provider Name (Legal Business Name): CARLOS ESPINOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8565 SW 109TH AVE
MIAMI FL
33173-4427
US

IV. Provider business mailing address

8565 SW 109TH AVE
MIAMI FL
33173-4427
US

V. Phone/Fax

Practice location:
  • Phone: 178-697-0299
  • Fax:
Mailing address:
  • Phone: 305-804-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-303712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: