Healthcare Provider Details

I. General information

NPI: 1700839495
Provider Name (Legal Business Name): ANDREA G ESPINOZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 INDUSTRIAL BLVD
HOUMA LA
70363-7055
US

IV. Provider business mailing address

1990 INDUSTRIAL BLVD
HOUMA LA
70363
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-9300
  • Fax: 985-851-0053
Mailing address:
  • Phone: 985-868-9300
  • Fax: 985-851-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number024932
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: