MEDICARE: MR. ROBERTO MIGUEL ESPANA

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	175F00000X	Naturopath	RND200045	NV

General Provider Information

NPI Number	:	1891039640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERTO MIGUEL ESPANA

Provider Business Mailing Address
First Line	:	1500 W SHAW AVE
Second Line	:	SUITE 404
City	:	FRESNO
State	:	CA
Zip	:	93711-3501
Country	:	US
Telephone Number	:	559-225-0356
Fax Number	:	559-230-0972

Provider Business Practice Location Address
First Line	:	1500 W SHAW AVE
Second Line	:	SUITE 404
City	:	FRESNO
State	:	CA
Zip	:	93711-3501
Country	:	US
Telephone Number	:	559-225-0356
Fax Number	:	559-230-0972

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

Provider Enumeration Date	:	11/17/2012
Last Update Date	:	11/17/2012

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