Provider Demographics
NPI:1518646009
Name:ESPINOSA OPIZO, DANIELA
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:ESPINOSA OPIZO
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 1:169 W TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1957
Mailing Address - Country:US
Mailing Address - Phone:305-345-3530
Mailing Address - Fax:
Practice Address - Street 1:169 W TRAIL DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-1957
Practice Address - Country:US
Practice Address - Phone:305-345-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-263654106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty