Provider Demographics
NPI:1033615695
Name:ESPINO-GROSSO, PEDRO MARIO (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:MARIO
Last Name:ESPINO-GROSSO
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 1:5850 CORAL RIDGE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3379
Mailing Address - Country:US
Mailing Address - Phone:954-714-8200
Mailing Address - Fax:954-840-2626
Practice Address - Street 1:5850 CORAL RIDGE DR STE 106
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3379
Practice Address - Country:US
Practice Address - Phone:954-714-8200
Practice Address - Fax:954-840-2626
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME162900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program