Provider Demographics
NPI:1285281642
Name:ESPINOSA PAGES, ELSA
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:ESPINOSA PAGES
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 1:4365 W 12TH LN APT B
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5931
Mailing Address - Country:US
Mailing Address - Phone:239-245-3614
Mailing Address - Fax:
Practice Address - Street 1:4365 W 12TH LN APT B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5931
Practice Address - Country:US
Practice Address - Phone:239-245-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL461334638Medicaid