Provider Demographics
NPI:1346792686
Name:ESPINOZA TORRES, FIDEL (MD)
Entity Type:Individual
Prefix:
First Name:FIDEL
Middle Name:
Last Name:ESPINOZA TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FIDEL
Other - Middle Name:
Other - Last Name:ESPINOZA TORRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4275 EXECUTIVE SQ
Mailing Address - Street 2:STE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9123
Mailing Address - Country:US
Mailing Address - Phone:800-743-3900
Mailing Address - Fax:866-272-6924
Practice Address - Street 1:CALLE DIAZ MIRON # 760
Practice Address - Street 2:STE 1 ZONA CENTRO
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:664-175-6274
Practice Address - Fax:866-272-6924
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ474245247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty