Healthcare Provider Details

I. General information

NPI: 1285397471
Provider Name (Legal Business Name): ESP CASE MANAGEMENT PROFESSIONAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/10/2023
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 BEVILLE RD STE A
SOUTH DAYTONA FL
32119-1970
US

IV. Provider business mailing address

687 BEVILLE RD STE A
SOUTH DAYTONA FL
32119-1970
US

V. Phone/Fax

Practice location:
  • Phone: 386-760-7533
  • Fax: 386-761-5868
Mailing address:
  • Phone: 386-760-7533
  • Fax: 386-761-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY L FAGARAGAN
Title or Position: PRESIDENT
Credential:
Phone: 386-760-7533