MEDICARE: PEDRO J ESPINO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1073071171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO J ESPINO

Provider Business Mailing Address
First Line	:	255 PARK AVE STE 500
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-1989
Country	:	US
Telephone Number	:	508-304-7397
Fax Number	:	508-304-7401

Provider Business Practice Location Address
First Line	:	255 PARK AVE STE 500
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-1989
Country	:	US
Telephone Number	:	508-304-7397
Fax Number	:	508-304-7401

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

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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Directions to “ PEDRO J ESPINO ” Practice Location

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