Healthcare Provider Details

I. General information

NPI: 1790169423
Provider Name (Legal Business Name): ANGELO RUTTY ESPINOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 VINELAND RD STE B
WINTER GARDEN FL
34787-3938
US

IV. Provider business mailing address

7620 LAKE UNDERHILL RD
ORLANDO FL
32822-8223
US

V. Phone/Fax

Practice location:
  • Phone: 407-978-0227
  • Fax:
Mailing address:
  • Phone: 412-587-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN946
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: