Provider Demographics
NPI:1073096327
Name:ESPINOSA, CELSO RAUL (OWNER)
Entity Type:Individual
Prefix:
First Name:CELSO
Middle Name:RAUL
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E NAKOMA ST # W2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2794
Mailing Address - Country:US
Mailing Address - Phone:210-404-4325
Mailing Address - Fax:
Practice Address - Street 1:314 E NAKOMA ST # W2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2794
Practice Address - Country:US
Practice Address - Phone:210-404-4325
Practice Address - Fax:210-429-8160
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor