Provider Demographics
NPI:1720667132
Name:ESPINOZA, SERGIO SR (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:ESPINOZA
Suffix:SR
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:MR
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:ESPINOZA
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1812 W SUNSET BLVD # 1-537
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:352 E RIVERSIDE DR # A-11
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6758
Practice Address - Country:US
Practice Address - Phone:714-232-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-04
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12153378-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty