Provider Demographics
NPI:1093544637
Name:ESPINOZA, ENNYLUZ C
Entity type:Individual
Prefix:
First Name:ENNYLUZ
Middle Name:C
Last Name: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 1:15924 SW 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1842
Mailing Address - Country:US
Mailing Address - Phone:305-964-5824
Mailing Address - Fax:786-452-1200
Practice Address - Street 1:205 LOCUST PASS TRCE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-6693
Practice Address - Country:US
Practice Address - Phone:786-444-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health