Provider Demographics
NPI:1093203150
Name:ESPINO, RICARDO E
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:E
Last Name:ESPINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3843 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4623
Mailing Address - Country:US
Mailing Address - Phone:773-884-2200
Mailing Address - Fax:
Practice Address - Street 1:8644 S 86TH AVE APT 113
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-2113
Practice Address - Country:US
Practice Address - Phone:708-546-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health