Healthcare Provider Details

I. General information

NPI: 1093544637
Provider Name (Legal Business Name): ENNYLUZ C ESPINOZA MARIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 LOCUST PASS TRCE
OCALA FL
34472-6693
US

IV. Provider business mailing address

15924 SW 92ND AVE
PALMETTO BAY FL
33157-1842
US

V. Phone/Fax

Practice location:
  • Phone: 786-444-2132
  • Fax:
Mailing address:
  • Phone: 305-964-5824
  • Fax: 786-452-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH26275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: