Healthcare Provider Details

I. General information

NPI: 1215604517
Provider Name (Legal Business Name): LIANA ESPINAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 NEW YORK AVE APT 1C
BROOKLYN NY
11213-4218
US

IV. Provider business mailing address

319 NEW YORK AVE APT 1C
BROOKLYN NY
11213-4218
US

V. Phone/Fax

Practice location:
  • Phone: 917-474-4161
  • Fax:
Mailing address:
  • Phone: 917-474-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number821042
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: