Provider Demographics
NPI:1740476977
Name:MARIUS C ESPELETA DPM PA
Entity type:Organization
Organization Name:MARIUS C ESPELETA DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIUS
Authorized Official - Middle Name:CHRISTIAAN
Authorized Official - Last Name:ESPELETA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-573-4825
Mailing Address - Street 1:PO BOX 151004
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-1004
Mailing Address - Country:US
Mailing Address - Phone:239-573-4825
Mailing Address - Fax:239-458-9850
Practice Address - Street 1:2002 DEL PRADO BLVD S STE 102
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4557
Practice Address - Country:US
Practice Address - Phone:239-573-4825
Practice Address - Fax:239-458-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2893213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5271450001Medicare NSC