Healthcare Provider Details

I. General information

NPI: 1508431313
Provider Name (Legal Business Name): AURELIO ESPINOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N 16TH ST STE 122
PHOENIX AZ
85006-1265
US

IV. Provider business mailing address

2701 N 16TH ST STE 316
PHOENIX AZ
85006-1266
US

V. Phone/Fax

Practice location:
  • Phone: 602-650-1212
  • Fax:
Mailing address:
  • Phone: 602-650-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-16984
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: