Healthcare Provider Details

I. General information

NPI: 1245121342
Provider Name (Legal Business Name): CONSUELO ESPANA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9765 RIVERSIDE CIR
ELLICOTT CITY MD
21042-5711
US

IV. Provider business mailing address

9765 RIVERSIDE CIR
ELLICOTT CITY MD
21042-5711
US

V. Phone/Fax

Practice location:
  • Phone: 410-212-8153
  • Fax: 667-400-7958
Mailing address:
  • Phone: 410-212-8153
  • Fax: 667-400-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL-00856
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: