Basic Information
| Provider Information | |||||||||
| NPI: | 1255637153 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESPINOZA | ||||||||
| FirstName: | RAQUEL | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6290 W SAMPLE RD | ||||||||
| Address2: | #102 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330673101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547572939 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6290 W SAMPLE RD | ||||||||
| Address2: | #102 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330673101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547572939 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2011 | ||||||||
| LastUpdateDate: | 02/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA57634 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.