Healthcare Provider Details

I. General information

NPI: 1588496103
Provider Name (Legal Business Name): MAYA ESPINOSA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 UPTOWN BLVD NE
ALBUQUERQUE NM
87110-4202
US

IV. Provider business mailing address

PO BOX 25704
ALBUQUERQUE NM
87125-0704
US

V. Phone/Fax

Practice location:
  • Phone: 505-855-9893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5906
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: