Provider Demographics
NPI:1033569017
Name:ESPINOZA, JAVIER (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6320
Mailing Address - Country:US
Mailing Address - Phone:580-581-2465
Mailing Address - Fax:580-581-5537
Practice Address - Street 1:2800 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6320
Practice Address - Country:US
Practice Address - Phone:580-581-2465
Practice Address - Fax:580-581-5537
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8912255A2300X
TXAT61012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer