Healthcare Provider Details

I. General information

NPI: 1689650707
Provider Name (Legal Business Name): KARL H ESPINOSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 S COUNTRY CLUB DR
MESA AZ
85210-6008
US

IV. Provider business mailing address

1950 S COUNTRY CLUB DR
MESA AZ
85210-6008
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-1446
  • Fax: 480-969-9105
Mailing address:
  • Phone: 480-969-1446
  • Fax: 480-969-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20402
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: