Healthcare Provider Details

I. General information

NPI: 1730916552
Provider Name (Legal Business Name): SELINA ESPINOZA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-2682
US

IV. Provider business mailing address

133 BENMORE DR STE 100
WINTER PARK FL
32792-4111
US

V. Phone/Fax

Practice location:
  • Phone: 505-322-6687
  • Fax: 505-369-3406
Mailing address:
  • Phone: 352-502-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: