Provider Demographics
NPI:1295343317
Name:GONZALEZ ESPINOSA, INRI ISMAEL
Entity type:Individual
Prefix:
First Name:INRI
Middle Name:ISMAEL
Last Name:GONZALEZ ESPINOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 VALLEY OAK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-0456
Mailing Address - Country:US
Mailing Address - Phone:901-921-6127
Mailing Address - Fax:
Practice Address - Street 1:6528 VALLEY OAK DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-0456
Practice Address - Country:US
Practice Address - Phone:901-921-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker