Healthcare Provider Details

I. General information

NPI: 1659334407
Provider Name (Legal Business Name): MAXIMILIEN RODOLFO ESPINAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 E ALLEGHENY AVE
PHILADELPHIA PA
19134-2328
US

IV. Provider business mailing address

224 W MENTOR ST
PHILADELPHIA PA
19120-4115
US

V. Phone/Fax

Practice location:
  • Phone: 215-291-9500
  • Fax: 215-291-1880
Mailing address:
  • Phone: 267-444-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number15414
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: