Healthcare Provider Details

I. General information

NPI: 1265237325
Provider Name (Legal Business Name): LUIS ESPINOSA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GLENRIDGE CONNECTOR STE 200
ATLANTA GA
30342-4815
US

IV. Provider business mailing address

1508 MARTIN MILL RD
MORELAND GA
30259-2526
US

V. Phone/Fax

Practice location:
  • Phone: 305-988-0135
  • Fax:
Mailing address:
  • Phone: 305-988-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN287170
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: