Provider Demographics
NPI:1760080626
Name:MURSULI ESPINOSA, ALENIA
Entity Type:Individual
Prefix:
First Name:ALENIA
Middle Name:
Last Name:MURSULI 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 1:717 MANUEL ST E
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-5704
Mailing Address - Country:US
Mailing Address - Phone:786-239-9780
Mailing Address - Fax:
Practice Address - Street 1:2519 39TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-6849
Practice Address - Country:US
Practice Address - Phone:786-239-9780
Practice Address - Fax:239-673-0517
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20125690103K00000X
FLRBT-20-125690106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst