Healthcare Provider Details

I. General information

NPI: 1790281046
Provider Name (Legal Business Name): KIANA ESPINOSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 10/17/2022
Certification Date: 10/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST STE 605
PHOENIX AZ
85006-2850
US

IV. Provider business mailing address

1300 N 12TH ST STE 605
PHOENIX AZ
85006-2850
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-4567
  • Fax:
Mailing address:
  • Phone: 602-839-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63498
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: