Healthcare Provider Details

I. General information

NPI: 1235098955
Provider Name (Legal Business Name): NOE DOMINGUEZ ESPARZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 28 3/4 RD BLDG F
GRAND JUNCTION CO
81501-5016
US

IV. Provider business mailing address

PO BOX 3807
GRAND JUNCTION CO
81502-3807
US

V. Phone/Fax

Practice location:
  • Phone: 970-245-4213
  • Fax: 970-243-8631
Mailing address:
  • Phone: 970-683-7211
  • Fax: 970-243-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.1670967
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: