Provider Demographics
NPI:1093861239
Name:ENRIQUE ESPINOSA-MELENDEZ MD INC
Entity Type:Organization
Organization Name:ENRIQUE ESPINOSA-MELENDEZ MD INC
Other - Org Name:CLINICA MEDICA CENTRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-943-9559
Mailing Address - Street 1:3802 NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-3223
Mailing Address - Country:US
Mailing Address - Phone:619-264-2591
Mailing Address - Fax:619-264-4116
Practice Address - Street 1:3802 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3223
Practice Address - Country:US
Practice Address - Phone:619-264-2591
Practice Address - Fax:619-264-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C427451Medicaid
CACLR333803OtherCLIA LAB REGISTRATION
CA00C427451Medicaid