MEDICARE: MR. BRYAN V ESPINOSA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	453	NV

General Provider Information

NPI Number	:	1255492856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN V ESPINOSA PA

Provider Business Mailing Address
First Line	:	1683 WINDSHIP CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-7559
Country	:	US
Telephone Number	:	702-287-8004
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 S RAINBOW BLVD STE 401
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4750
Country	:	US
Telephone Number	:	702-644-7246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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