Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | ME121742 | FL |
NPI | 1013036359 |
---|---|
Provider Name | Victor Hugo Espinosa |
First Address | Boca Raton, FL 33486-1009 |
Second Address | Boca Raton, FL 33486-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 20/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001632835 | (02) | IL |