Provider Demographics
NPI:1508176470
Name:EISEN J. ESPINA, M.D., P.A.
Entity Type:Organization
Organization Name:EISEN J. ESPINA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EISEN
Authorized Official - Middle Name:JOVER
Authorized Official - Last Name:ESPINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-993-9500
Mailing Address - Street 1:5525 S STAPLES ST
Mailing Address - Street 2:STE. E2
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5357
Mailing Address - Country:US
Mailing Address - Phone:361-993-9500
Mailing Address - Fax:361-993-7933
Practice Address - Street 1:5525 S STAPLES ST
Practice Address - Street 2:STE. E2
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5357
Practice Address - Country:US
Practice Address - Phone:361-993-9500
Practice Address - Fax:361-993-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9621261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15502Medicare UPIN