Healthcare Provider Details

I. General information

NPI: 1003846759
Provider Name (Legal Business Name): ESPAILLAT MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST SUITE 603
MIAMI FL
33125-1673
US

IV. Provider business mailing address

1321 NW 14TH ST SUITE 603
MIAMI FL
33125-1673
US

V. Phone/Fax

Practice location:
  • Phone: 305-545-9393
  • Fax: 305-547-2393
Mailing address:
  • Phone: 305-545-9393
  • Fax: 305-547-2393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC2749
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME81887
License Number StateFL

VIII. Authorized Official

Name: ALEJANDRO ESPAILLAT
Title or Position: PRESIDENT
Credential: MD
Phone: 305-545-9393