Healthcare Provider Details

I. General information

NPI: 1588293658
Provider Name (Legal Business Name): CORAL ESPARZA LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2944 BREEZEWOOD AVE STE 202
FAYETTEVILLE NC
28303-5415
US

IV. Provider business mailing address

5994 BLUE TEAL CT
FAYETTEVILLE NC
28304-5680
US

V. Phone/Fax

Practice location:
  • Phone: 910-670-0582
  • Fax:
Mailing address:
  • Phone: 210-823-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17851
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: