Provider Demographics
NPI:1750797759
Name:ESPINOSA HEALTH PLAZA PLLC
Entity type:Organization
Organization Name:ESPINOSA HEALTH PLAZA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHFOOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-793-7550
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:4526 PINE ST
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48421-0007
Mailing Address - Country:US
Mailing Address - Phone:810-793-7550
Mailing Address - Fax:810-793-7962
Practice Address - Street 1:4526 PINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIAVILLE
Practice Address - State:MI
Practice Address - Zip Code:48421-0007
Practice Address - Country:US
Practice Address - Phone:810-793-7550
Practice Address - Fax:810-793-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINM059644172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty