Provider Demographics
NPI:1750983284
Name:MEGO ESPINOZA, CARMEN ROSA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROSA
Last Name:MEGO ESPINOZA
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 1:4913 QUINCE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-8160
Mailing Address - Country:US
Mailing Address - Phone:956-451-1357
Mailing Address - Fax:
Practice Address - Street 1:4913 QUINCE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-8160
Practice Address - Country:US
Practice Address - Phone:956-451-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR022056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine