Provider Demographics
NPI:1245405687
Name:ESPINOZA, MICHAEL ANTHONY (IDC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 466
Mailing Address - Street 2:BOX 3
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96595-0466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 466
Practice Address - Street 2:BOX 3
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96595-0466
Practice Address - Country:US
Practice Address - Phone:370-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman