Provider Demographics
NPI:1679904783
Name:MIGDALIA ESPINO
Entity Type:Organization
Organization Name:MIGDALIA ESPINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINO
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:787-390-1585
Mailing Address - Street 1:2305 CALLE LAUREL
Mailing Address - Street 2:CONDOMINIO PARK BLVD APT 404
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00913-4605
Mailing Address - Country:US
Mailing Address - Phone:787-390-1585
Mailing Address - Fax:
Practice Address - Street 1:2305 CALLE LAUREL
Practice Address - Street 2:CONDOMINIO PARK BLVD APT 404
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00913-4605
Practice Address - Country:US
Practice Address - Phone:787-390-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2845261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid