Provider Demographics
NPI:1407882210
Name:ESPINO, JOSE (RCSA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ESPINO
Suffix:
Gender:M
Credentials:RCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88543
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-0543
Mailing Address - Country:US
Mailing Address - Phone:630-330-0200
Mailing Address - Fax:630-762-9681
Practice Address - Street 1:2373 WHITE ROSE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-5140
Practice Address - Country:US
Practice Address - Phone:630-330-0200
Practice Address - Fax:630-762-9681
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000022208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1376701805OtherNPI FOR STARSURGICAL