MEDICARE: PROF. WALDO OSCAR ESPARZA B.S., C.P.

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	1744P3200X	Prosthetics Case Management	PRO 25	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	290808	OTHER	FL	STAYWELL
2	V516P-7063	OTHER	FL	VA VENDOR #
3	7376145	OTHER	FL	AETNA EPDB PIN #
4	R9100	OTHER	FL	BLUE CROSS BLUE SHIELD FL

General Provider Information

NPI Number	:	1528096773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. WALDO OSCAR ESPARZA B.S., C.P.

Provider Business Mailing Address
First Line	:	5109 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1405
Country	:	US
Telephone Number	:	813-801-9110
Fax Number	:	813-801-9048

Provider Business Practice Location Address
First Line	:	5109 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1405
Country	:	US
Telephone Number	:	813-801-9110
Fax Number	:	813-801-9048

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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