Healthcare Provider Details

I. General information

NPI: 1780613455
Provider Name (Legal Business Name): PAUL MANUEL ESPINOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 PARK PLACE CT
LEXINGTON SC
29072-6690
US

IV. Provider business mailing address

117 PARK PLACE CT
LEXINGTON SC
29072-6690
US

V. Phone/Fax

Practice location:
  • Phone: 38-626-9075
  • Fax: 803-626-1105
Mailing address:
  • Phone: 38-626-9075
  • Fax: 803-626-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20284
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number20284
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: