Provider Demographics
NPI:1013036359
Name:ESPINOSA, VICTOR HUGO (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:HUGO
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 TOWN CENTER RD STE 17
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1009
Mailing Address - Country:US
Mailing Address - Phone:561-465-3507
Mailing Address - Fax:561-465-3567
Practice Address - Street 1:5458 TOWN CENTER RD STE 17
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1009
Practice Address - Country:US
Practice Address - Phone:561-465-3507
Practice Address - Fax:561-465-3567
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121742207QS0010X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001632835Medicare UPIN
IL203730Medicare ID - Type Unspecified