Provider Demographics
NPI:1326333964
Name:ESPINOSA, JORGE LUIS (MT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 W 20TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1829
Mailing Address - Country:US
Mailing Address - Phone:305-819-8755
Mailing Address - Fax:305-819-8755
Practice Address - Street 1:7760 W 20TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1829
Practice Address - Country:US
Practice Address - Phone:305-819-8755
Practice Address - Fax:305-819-8755
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57857225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist