MEDICARE: JOSE PEREZ ESPINOSA MD PA

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	207Q00000X	Family Medicine Physician	ME0023804	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001144	OTHER	FL	NEIGHBORHOOD HEALTH PLANS
2	011811	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1891948758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE PEREZ ESPINOSA MD PA

Provider Business Mailing Address
First Line	:	4990 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3726
Country	:	US
Telephone Number	:	305-444-1401
Fax Number	:	305-444-4113

Provider Business Practice Location Address
First Line	:	4990 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3726
Country	:	US
Telephone Number	:	305-444-1401
Fax Number	:	305-444-4113

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. EVA DIAZ
Credential	:
Telephone Number	:	305-444-1401

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	08/02/2010

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