Healthcare Provider Details

I. General information

NPI: 1518985191
Provider Name (Legal Business Name): GUSTAVO ABEL ESPINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/04/2023
Certification Date: 03/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 PAN AMERICAN FWY NE STE 236
ALBUQUERQUE NM
87107-6834
US

IV. Provider business mailing address

4343 PAN AMERICAN FWY NE STE 236
ALBUQUERQUE NM
87107-6834
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-2511
  • Fax: 505-300-4977
Mailing address:
  • Phone: 505-600-2511
  • Fax: 505-300-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number98-49
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: