Provider Demographics
NPI:1659334407
Name:ESPINAL, MAXIMILIEN RODOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIMILIEN
Middle Name:RODOLFO
Last Name:ESPINAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W MENTOR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4115
Mailing Address - Country:US
Mailing Address - Phone:267-444-6658
Mailing Address - Fax:
Practice Address - Street 1:537 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2328
Practice Address - Country:US
Practice Address - Phone:215-291-9500
Practice Address - Fax:215-291-1880
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15414146D00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant