Healthcare Provider Details

I. General information

NPI: 1689968018
Provider Name (Legal Business Name): ELAINE ESPANOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 SUNSET DR SUITE 101
MIAMI FL
33173-3259
US

IV. Provider business mailing address

8001 SW 36TH ST SUITE 9
DAVIE FL
33328-1915
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-7790
  • Fax: 954-577-7780
Mailing address:
  • Phone: 954-577-7790
  • Fax: 954-577-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: