=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376950386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUGO MARTIN ESPINOSA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2014
-----------------------------------------------------
Last Update Date | 07/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7171 SW 24TH ST STE # 104
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-1449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-518-3843
-----------------------------------------------------
Fax | 786-518-3856
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7171 SW 24TH ST STE # 104
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-1449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-518-3843
-----------------------------------------------------
Fax | 786-518-3856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HUGO MARTIN ESPINOSA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-518-3843
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME116074
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------