Provider Demographics
NPI:1093845661
Name:ESPINOZA, EARL E (LMP)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:E
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2235
Mailing Address - Country:US
Mailing Address - Phone:360-635-3707
Mailing Address - Fax:360-693-1688
Practice Address - Street 1:3606 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2235
Practice Address - Country:US
Practice Address - Phone:360-635-3707
Practice Address - Fax:360-693-1688
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist