Provider Demographics
NPI:1528096773
Name:ESPARZA, WALDO OSCAR (BS, CP)
Entity type:Individual
Prefix:PROF
First Name:WALDO
Middle Name:OSCAR
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:BS, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1405
Mailing Address - Country:US
Mailing Address - Phone:813-801-9110
Mailing Address - Fax:813-801-9048
Practice Address - Street 1:5109 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1405
Practice Address - Country:US
Practice Address - Phone:813-801-9110
Practice Address - Fax:813-801-9048
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPRO 251744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290808OtherSTAYWELL
FLV516P-7063OtherVA VENDOR #
FL7376145OtherAETNA EPDB PIN #
FLR9100OtherBLUE CROSS BLUE SHIELD FL
FLV516P-7063OtherVA VENDOR #