Provider Demographics
NPI:1700840881
Name:ESPEJO-KONG, MARIA GRACIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:GRACIA
Last Name:ESPEJO-KONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:KONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 AVENUE O SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4333
Mailing Address - Country:US
Mailing Address - Phone:863-294-7039
Mailing Address - Fax:
Practice Address - Street 1:101 AVENUE O SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4333
Practice Address - Country:US
Practice Address - Phone:863-294-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME437662080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine