Healthcare Provider Details

I. General information

NPI: 1326354556
Provider Name (Legal Business Name): MARTA M ESPADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLA MADRID CALLE17 W17
COAMO PR
00769
US

IV. Provider business mailing address

URB VILLA MADRID CALLE17 W17
COAMO PR
00769
US

V. Phone/Fax

Practice location:
  • Phone: 787-372-9496
  • Fax: 787-844-4130
Mailing address:
  • Phone: 787-372-9496
  • Fax: 787-844-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACII15628633
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: