Provider Demographics
NPI:1578919361
Name:ESPADA, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ESPADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 SW 112TH WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-4540
Mailing Address - Country:US
Mailing Address - Phone:786-763-6957
Mailing Address - Fax:
Practice Address - Street 1:1155 SW 112TH WAY
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-4540
Practice Address - Country:US
Practice Address - Phone:786-763-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46-5483249OtherEIN NUMBER