Provider Demographics
NPI:1912999814
Name:ESPELETA, MARIUS C (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARIUS
Middle Name:C
Last Name:ESPELETA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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:239-573-4826
Mailing Address - Fax:239-573-4827
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:239-573-4826
Practice Address - Fax:239-573-4827
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2893213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912999814Medicare NSC
FLU84502Medicare UPIN