Basic Information
| Provider Information | |||||||||
| NPI: | 1659334407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESPINAL | ||||||||
| FirstName: | MAXIMILIEN | ||||||||
| MiddleName: | RODOLFO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 W MENTOR ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191204115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2674446658 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 537 E ALLEGHENY AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191342328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152919500 | ||||||||
| FaxNumber: | 2152911880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 02/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | 15414 | PR | N | Emergency Medical Service Providers | Personal Emergency Response Attendant | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.