Provider Demographics
NPI:1235226226
Name:ESPAILLAT, JOSEFINA
Entity Type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:
Last Name:ESPAILLAT
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 1:506 BLVD MEDIA LUNA
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4987
Mailing Address - Country:US
Mailing Address - Phone:787-672-4947
Mailing Address - Fax:
Practice Address - Street 1:506 BLVD MEDIA LUNA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-4987
Practice Address - Country:US
Practice Address - Phone:787-672-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15030174400000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022072Medicare ID - Type UnspecifiedHEALTH PROVIDER
PRH96917Medicare UPIN