Provider Demographics
NPI:1922028224
Name:ESPINOSA, FABIAN (MD)
Entity Type:Individual
Prefix:
First Name:FABIAN
Middle Name:
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 HOSPITAL DR
Mailing Address - Street 2:200
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5701
Mailing Address - Country:US
Mailing Address - Phone:361-574-1820
Mailing Address - Fax:361-574-1821
Practice Address - Street 1:2710 HOSPITAL DR
Practice Address - Street 2:200
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5701
Practice Address - Country:US
Practice Address - Phone:361-574-1820
Practice Address - Fax:361-574-1821
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101789902Medicaid
TX85351GOtherBLUE CROSS
TX85351GOtherBLUE CROSS
TX101789902Medicaid
TXG76962Medicare UPIN