Healthcare Provider Details

I. General information

NPI: 1366403511
Provider Name (Legal Business Name): VICENTE RODRIGO ESPARZA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HOSPITAL RD WACHUSETT EMERGENCY PHYSICIANS
LEOMINSTER MA
01453
US

IV. Provider business mailing address

60 HOSPITAL RD WACHUSETT EMERGENCY PHYSICIANS
LEOMINSTER MA
01453
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-2994
  • Fax: 978-466-2993
Mailing address:
  • Phone: 978-466-2994
  • Fax: 978-466-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110896
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1229
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: