Healthcare Provider Details

I. General information

NPI: 1700201365
Provider Name (Legal Business Name): EUNICE ESPARZA LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 PERSHING RD
BERWYN IL
60402-4046
US

IV. Provider business mailing address

6530 PERSHING RD
BERWYN IL
60402-4046
US

V. Phone/Fax

Practice location:
  • Phone: 630-688-8506
  • Fax:
Mailing address:
  • Phone: 630-688-8506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.012149
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: