Provider Demographics
NPI:1194798967
Name:ESPINOSA, CARLOS A (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450649
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0015
Mailing Address - Country:US
Mailing Address - Phone:956-717-0113
Mailing Address - Fax:956-717-2070
Practice Address - Street 1:6801 MCPHERSON AVE
Practice Address - Street 2:SUITE 223
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6402
Practice Address - Country:US
Practice Address - Phone:956-717-0113
Practice Address - Fax:956-717-2070
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4418207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742864230OtherCOMMERCIAL
TX029465401Medicaid
TX029465401Medicaid
TX00053DMedicare ID - Type Unspecified