Healthcare Provider Details

I. General information

NPI: 1275424053
Provider Name (Legal Business Name): VINCENT ESPINOZA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 JUAN TABO BLVD NE STE 2B
ALBUQUERQUE NM
87111-2691
US

IV. Provider business mailing address

7502 REGISTRAR WAY
SARASOTA FL
34243-2526
US

V. Phone/Fax

Practice location:
  • Phone: 505-500-4125
  • Fax:
Mailing address:
  • Phone: 505-500-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: VINCENT ESPINOZA
Title or Position: OWNER
Credential:
Phone: 505-500-4125