Provider Demographics
NPI:1053534628
Name:ESPINOZA, LISA C (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 UNION SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-1367
Mailing Address - Country:US
Mailing Address - Phone:215-862-6100
Mailing Address - Fax:
Practice Address - Street 1:430 UNION SQUARE DR
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-1367
Practice Address - Country:US
Practice Address - Phone:215-862-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08119000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ120343QMJMedicare PIN