Healthcare Provider Details

I. General information

NPI: 1801347976
Provider Name (Legal Business Name): SAMUEL ESPINOSA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 05/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 NW 22ND CT
MIAMI FL
33142-8417
US

IV. Provider business mailing address

2330 NW 22ND CT
MIAMI FL
33142-8417
US

V. Phone/Fax

Practice location:
  • Phone: 910-526-7010
  • Fax:
Mailing address:
  • Phone: 910-526-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: