Provider Demographics
NPI:1851583926
Name:ESPINOLA, RICARDO (MPT)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:ESPINOLA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 HEMLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-3435
Mailing Address - Country:US
Mailing Address - Phone:619-429-8275
Mailing Address - Fax:
Practice Address - Street 1:4350 MOUNT EVEREST BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4847
Practice Address - Country:US
Practice Address - Phone:858-573-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist