Provider Demographics
NPI:1992046577
Name:ESPIRITU, IMMACULADA SANTIAGO (MD)
Entity type:Individual
Prefix:DR
First Name:IMMACULADA
Middle Name:SANTIAGO
Last Name:ESPIRITU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 VANDALIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2843
Mailing Address - Country:US
Mailing Address - Phone:718-264-4291
Mailing Address - Fax:
Practice Address - Street 1:750 VANDALIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2843
Practice Address - Country:US
Practice Address - Phone:718-264-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272301208000000X, 2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics