Provider Demographics
NPI:1316634892
Name:ESPINO, MANDIE
Entity type:Individual
Prefix:
First Name:MANDIE
Middle Name:
Last Name:ESPINO
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 1:563 PACHMAN CIR
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-9483
Mailing Address - Country:US
Mailing Address - Phone:239-839-2983
Mailing Address - Fax:239-320-5117
Practice Address - Street 1:563 PACHMAN CIR
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974-9483
Practice Address - Country:US
Practice Address - Phone:239-839-2983
Practice Address - Fax:239-320-5117
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities