Healthcare Provider Details

I. General information

NPI: 1346449220
Provider Name (Legal Business Name): RICARDO ESPINOSA P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 NW 36TH ST
VIRGINIA GARDENS FL
33166-7026
US

IV. Provider business mailing address

4483 NW 36TH ST SUITE 120
MIAMI SPRINGS FL
33166-7260
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-3627
  • Fax: 305-871-7569
Mailing address:
  • Phone: 305-888-7555
  • Fax: 305-888-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9100094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: