Provider Demographics
NPI:1215563861
Name:ESPAILLAT MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:ESPAILLAT MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPAILLAT PRESTOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-234-8264
Mailing Address - Street 1:PO BOX 144295
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-4295
Mailing Address - Country:US
Mailing Address - Phone:305-234-8264
Mailing Address - Fax:305-255-1752
Practice Address - Street 1:12002 SW 128TH CT STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4643
Practice Address - Country:US
Practice Address - Phone:305-234-8264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME128770OtherMEDICAL LICENSE