Provider Demographics
NPI:1326284183
Name:MANUEL G ESPINOZA MD PA
Entity Type:Organization
Organization Name:MANUEL G ESPINOZA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-230-1404
Mailing Address - Street 1:512 VICTORIA LN
Mailing Address - Street 2:SUITE 15
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3226
Mailing Address - Country:US
Mailing Address - Phone:956-230-1404
Mailing Address - Fax:956-230-1679
Practice Address - Street 1:512 VICTORIA LN
Practice Address - Street 2:SUITE 15
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3226
Practice Address - Country:US
Practice Address - Phone:956-230-1404
Practice Address - Fax:956-230-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0752208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3128Medicare PIN