Provider Demographics
NPI:1891039640
Name:ESPANA, ROBERTO MIGUEL
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:MIGUEL
Last Name:ESPANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:MIGUEL
Other - Last Name:ESPANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RND
Mailing Address - Street 1:1500 W SHAW AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3501
Mailing Address - Country:US
Mailing Address - Phone:559-225-0356
Mailing Address - Fax:559-230-0972
Practice Address - Street 1:1500 W SHAW AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3501
Practice Address - Country:US
Practice Address - Phone:559-225-0356
Practice Address - Fax:559-230-0972
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRND200045175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath