Provider Demographics
NPI:1609979632
Name:ESPINA-HERNANDEZ, LOURDES (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:
Last Name:ESPINA-HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4761 RINGWOOD MDW
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-7228
Mailing Address - Country:US
Mailing Address - Phone:941-379-6509
Mailing Address - Fax:
Practice Address - Street 1:4761 RINGWOOD MDW
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-7228
Practice Address - Country:US
Practice Address - Phone:941-379-6509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF37715207R00000X
FLME81364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26826000Medicaid
F37715Medicare UPIN
FL58560Medicare ID - Type Unspecified