Healthcare Provider Details

I. General information

NPI: 1083653141
Provider Name (Legal Business Name): MARIO ESPINOSA GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CALLE SANTA CRUZ SUITE 404 INSTITUTO SAN PABLO
BAYAMON PR
00961-7041
US

IV. Provider business mailing address

66 CALLE SANTA CRUZ SUITE 404 INSTITUTO SAN PABLO
BAYAMON PR
00961-7041
US

V. Phone/Fax

Practice location:
  • Phone: 787-449-4486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5005
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: