Provider Demographics
NPI:1790381606
Name:ESPINOSA, AYTSA
Entity Type:Individual
Prefix:
First Name:AYTSA
Middle Name:
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 1:13796 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1163
Mailing Address - Country:US
Mailing Address - Phone:305-235-4368
Mailing Address - Fax:786-249-0014
Practice Address - Street 1:13796 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1163
Practice Address - Country:US
Practice Address - Phone:305-235-4368
Practice Address - Fax:786-249-0014
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist