Healthcare Provider Details

I. General information

NPI: 1295764785
Provider Name (Legal Business Name): LUIS A ESPINOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1500 NW 12TH AVE JMT-EAST 1007
MIAMI FL
33136-1028
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1111
  • Fax: 305-243-9927
Mailing address:
  • Phone: 305-243-4664
  • Fax: 305-243-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME78228
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME78228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: