Provider Demographics
NPI:1861557936
Name:ESPERANZA BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:ESPERANZA BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDESVINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS-ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-226-3733
Mailing Address - Street 1:7350 FUTURES DR
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9083
Mailing Address - Country:US
Mailing Address - Phone:407-226-3733
Mailing Address - Fax:407-226-3734
Practice Address - Street 1:7350 FUTURES DR
Practice Address - Street 2:SUITE 16
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9083
Practice Address - Country:US
Practice Address - Phone:407-226-3733
Practice Address - Fax:407-226-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
FLME796342084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271060900Medicaid
FL271060900Medicaid
FLAA873Medicare PIN