Provider Demographics
NPI:1366403511
Name:ESPARZA, VICENTE RODRIGO (PA)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:RODRIGO
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HOSPITAL RD
Mailing Address - Street 2:WACHUSETT EMERGENCY PHYSICIANS
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-466-2994
Mailing Address - Fax:978-466-2993
Practice Address - Street 1:60 HOSPITAL RD
Practice Address - Street 2:WACHUSETT EMERGENCY PHYSICIANS
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-2994
Practice Address - Fax:978-466-2993
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110896363A00000X
MA1229363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1720Medicare ID - Type Unspecified
P59808Medicare UPIN