Basic Information
| Provider Information | |||||||||
| NPI: | 1891771812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESPAILLAT | ||||||||
| FirstName: | ALEJANDRO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 BLUE LAGOON DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331263168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055002000 | ||||||||
| FaxNumber: | 9544284909 | ||||||||
| Practice Location | |||||||||
| Address1: | 1979 W HILLSBORO BLVD STE 4 | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334421444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544284800 | ||||||||
| FaxNumber: | 9544284909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME81887 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 449-9224 | 01 | ECFMG | OTHER | E5584T | 01 | PTAN | OTHER | 449-922-4 | 01 | FNIN | OTHER | 101886300 | 05 | FL | MEDICAID | ME81887 | 01 | FL | MEDICAL LICENSE | OTHER | 207W00000X | 01 | TAXONOMY CODE | OTHER | 10727084 | 01 | CAQH | OTHER |