Provider Demographics
NPI:1245121342
Name:ESPANA, CONSUELO
Entity type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:ESPANA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9765 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5711
Mailing Address - Country:US
Mailing Address - Phone:410-212-8153
Mailing Address - Fax:667-400-7958
Practice Address - Street 1:9765 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5711
Practice Address - Country:US
Practice Address - Phone:410-212-8153
Practice Address - Fax:667-400-7958
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAL-00856310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility