MEDICARE: MR. LUIS ESPINOSA JR.

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1841608486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS ESPINOSA JR.

Provider Business Mailing Address
First Line	:	PO BOX 571703
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89157-1703
Country	:	US
Telephone Number	:	702-301-1122
Fax Number	:

Provider Business Practice Location Address
First Line	:	5236 APPLE VALLEY LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1402
Country	:	US
Telephone Number	:	702-301-1122
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	07/28/2014

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