Healthcare Provider Details

I. General information

NPI: 1407882210
Provider Name (Legal Business Name): JOSE ESPINO RCSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 WHITE ROSE DR
MONTGOMERY IL
60538-5140
US

IV. Provider business mailing address

PO BOX 88543
CAROL STREAM IL
60188-0543
US

V. Phone/Fax

Practice location:
  • Phone: 630-330-0200
  • Fax: 630-762-9681
Mailing address:
  • Phone: 630-330-0200
  • Fax: 630-762-9681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number238.000022
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: