Provider Demographics
NPI:1730894601
Name:MOYA ESPINOSA, MILDREY
Entity type:Individual
Prefix:
First Name:MILDREY
Middle Name:
Last Name:MOYA ESPINOSA
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 1:1655 W 44TH PL APT 551
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7439
Mailing Address - Country:US
Mailing Address - Phone:786-447-2398
Mailing Address - Fax:
Practice Address - Street 1:1655 W 44TH PL APT 551
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7439
Practice Address - Country:US
Practice Address - Phone:786-447-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-250304106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician