Provider Demographics
NPI:1871336461
Name:MARTIN ESPINOZA, ANTHONY N
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:N
Last Name:MARTIN ESPINOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 TEOLI CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4691
Mailing Address - Country:US
Mailing Address - Phone:786-612-4145
Mailing Address - Fax:
Practice Address - Street 1:4517 TEOLI CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4691
Practice Address - Country:US
Practice Address - Phone:786-612-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician