Healthcare Provider Details

I. General information

NPI: 1083651178
Provider Name (Legal Business Name): FERNANDO ESPARZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2698 SW 87TH AVE
MIAMI FL
33165-2000
US

IV. Provider business mailing address

2698 SW 87TH AVE
MIAMI FL
33165-2000
US

V. Phone/Fax

Practice location:
  • Phone: 305-461-4417
  • Fax: 305-461-4685
Mailing address:
  • Phone: 305-461-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME58429
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: