Provider Demographics
NPI:1114395365
Name:ESPINOZA, PERLA
Entity Type:Individual
Prefix:
First Name:PERLA
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N 32ND CT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6130
Mailing Address - Country:US
Mailing Address - Phone:754-802-0422
Mailing Address - Fax:
Practice Address - Street 1:9500 NW 77TH AVE
Practice Address - Street 2:#3
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2530
Practice Address - Country:US
Practice Address - Phone:786-429-7313
Practice Address - Fax:786-391-2963
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 13820224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant