Provider Demographics
NPI:1457882144
Name:ESPINOSA, ODEIMI
Entity Type:Individual
Prefix:
First Name:ODEIMI
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 1:4675 W 18TH CT
Mailing Address - Street 2:APT 711
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2863
Mailing Address - Country:US
Mailing Address - Phone:786-991-3714
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:4675 W 18TH CT
Practice Address - Street 2:APT 711
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2863
Practice Address - Country:US
Practice Address - Phone:786-991-3714
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician