MEDICARE: MR. RICARDO ESPINOLA MPT

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	225100000X	Physical Therapist	24202	CA

General Provider Information

NPI Number	:	1851583926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICARDO ESPINOLA MPT

Provider Business Mailing Address
First Line	:	972 HEMLOCK AVE
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91932-3435
Country	:	US
Telephone Number	:	619-429-8275
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 MOUNT EVEREST BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4847
Country	:	US
Telephone Number	:	858-573-5971
Fax Number	:

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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