Provider Demographics
NPI:1679740930
Name:ESPINAL RODRIGUEZ, MIGUEL ANTONIO (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANTONIO
Last Name:ESPINAL RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 WILLOW BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7456
Mailing Address - Country:US
Mailing Address - Phone:917-721-9566
Mailing Address - Fax:
Practice Address - Street 1:1475 WILLOW BRANCH DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7456
Practice Address - Country:US
Practice Address - Phone:917-721-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical