Healthcare Provider Details

I. General information

NPI: 1841045663
Provider Name (Legal Business Name): MARIEL DE LOS ANGELES ESPINAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CARLISLE PL
YONKERS NY
10701-3101
US

IV. Provider business mailing address

9 CARLISLE PL
YONKERS NY
10701-3101
US

V. Phone/Fax

Practice location:
  • Phone: 347-366-7722
  • Fax:
Mailing address:
  • Phone: 347-366-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2543886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: