Provider Demographics
NPI:1366311961
Name:ESPINOSA MARINO, LARITZA DE JESUS
Entity type:Individual
Prefix:
First Name:LARITZA
Middle Name:DE JESUS
Last Name:ESPINOSA MARINO
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 1:5081 MINA CIR APT 404
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7848
Mailing Address - Country:US
Mailing Address - Phone:786-794-8649
Mailing Address - Fax:
Practice Address - Street 1:5081 MINA CIR APT 404
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7848
Practice Address - Country:US
Practice Address - Phone:786-794-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-485985106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician