Healthcare Provider Details

I. General information

NPI: 1649132481
Provider Name (Legal Business Name): IAN ESPINOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 HARLAN ST
LAKEWOOD CO
80214-2340
US

IV. Provider business mailing address

1804 MANASSA ST
PUEBLO CO
81001-1132
US

V. Phone/Fax

Practice location:
  • Phone: 720-630-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberQ230113
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: