MEDICARE: DAIMARIE ESPADA MSW

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	1041C0700X	Clinical Social Worker	13760	PR

General Provider Information

NPI Number	:	1811467145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAIMARIE ESPADA MSW

Provider Business Mailing Address
First Line	:	PO BOX 933
Second Line	:
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-0933
Country	:	US
Telephone Number	:	787-452-2276
Fax Number	:

Provider Business Practice Location Address
First Line	:	996 CALLE ROBERTO
Second Line	:	SUITE 3001
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-641-0773
Fax Number	:

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

Provider Enumeration Date	:	11/29/2018
Last Update Date	:	11/29/2018

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