Provider Demographics
NPI:1174527931
Name:ESPINO, GONZALO A (MD, MSA)
Entity type:Individual
Prefix:
First Name:GONZALO
Middle Name:A
Last Name:ESPINO
Suffix:
Gender:M
Credentials:MD, MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4317
Mailing Address - Country:US
Mailing Address - Phone:904-387-3124
Mailing Address - Fax:904-387-3134
Practice Address - Street 1:2315 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4317
Practice Address - Country:US
Practice Address - Phone:904-387-3124
Practice Address - Fax:904-387-3134
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist