Provider Demographics
NPI:1629628656
Name:ESPONGE, PATRICK
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:ESPONGE
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 1:303 S SHORT ST
Mailing Address - Street 2:
Mailing Address - City:DELCAMBRE
Mailing Address - State:LA
Mailing Address - Zip Code:70528-4509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 S SHORT ST
Practice Address - Street 2:
Practice Address - City:DELCAMBRE
Practice Address - State:LA
Practice Address - Zip Code:70528-4509
Practice Address - Country:US
Practice Address - Phone:337-224-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker