MEDICARE: MR. JAMES ARNEL CRUZ ESPINOZA ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT-296	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2000020269	OTHER	CA	BOARD OF CERTIFICATION ATC

General Provider Information

NPI Number	:	1063938041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ARNEL CRUZ ESPINOZA ATC

Provider Business Mailing Address
First Line	:	1166 FORT ST STE 102
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2785
Country	:	US
Telephone Number	:	808-544-9360
Fax Number	:	808-543-8032

Provider Business Practice Location Address
First Line	:	1166 FORT ST STE 102
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2785
Country	:	US
Telephone Number	:	808-544-9360
Fax Number	:	808-543-8032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	07/21/2022

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