MEDICARE: MANDIE 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1316634892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDIE ESPINO

Provider Business Mailing Address
First Line	:	563 PACHMAN CIR
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33974-9483
Country	:	US
Telephone Number	:	239-839-2983
Fax Number	:	239-320-5117

Provider Business Practice Location Address
First Line	:	563 PACHMAN CIR
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33974-9483
Country	:	US
Telephone Number	:	239-839-2983
Fax Number	:	239-320-5117

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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Directions to “ MANDIE ESPINO ” Practice Location

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