Provider Demographics
NPI:1720571409
Name:ESPINOSA, VICTORIA MARIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIA
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12133 SUGAR PINE TRL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5641
Mailing Address - Country:US
Mailing Address - Phone:561-932-9488
Mailing Address - Fax:
Practice Address - Street 1:12133 SUGAR PINE TRL
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5641
Practice Address - Country:US
Practice Address - Phone:561-932-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLL22000233492222Q00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty